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MORBIDITY AND MORTALITY OF MULTIFETAL GESTATION LESS THAN 1500 GRAMS

The clinical courses and outcomes of 61 twins and 9 triplets with birthweights less than 1500 grams (multifetal group, MFG) and delivered at Women's Hospital between Jan. 1980 and June 1983 were compared to all 174 inborn singletons less than 1500 grams (singleton group, SG) delivered during the same interval.MFG infants were significantly smaller (birthweights 976 ± 277 g v. 1111 ± 238 g for SG, p<0.001) and more premature (gestational ages 28.2 ± 2 wks v. 29.3 ± 3 wks for SG, p<0.01). Mortality for the MFG was 39%, compared to only 17% in the SG, p < 0.001.Analysis of obstetric factors between MFG and SG showed premature onset of labor (p < 0.001) and cesarean section (CS) following labor (p < 0.001) to be more common in the MFG, while CS without labor was more common in the SG (p = 0.002).The incidence of respiratory distress (RD), IPPV and FiO2 ≥ 0.4, was higher in the MFG (83%) than in the SG (69%), p<0.05. The overall incidence and severity of intraventricular hemorrhage (IVH) was similar in both groups, though factors associated with IVH differed. Among the MFG, IVH was more commonly seen only in infants with RD. For the SG, IVH was more common with birthweight <1000 g (p = 0.02), 5 minute Apgar ≤ 5 (p<0.03), RD (p<0.0001), and death (p<0.0001). Postnatal phenobarbital therapy reduced the incidence of IVH in the SG from 37% to 17%, but had no apparent effect in the MFG.We conclude that MFG infants tend to be more premature and smaller than SG infants, and have an increased risk of mortality which does not appear related to IVH.