DEVELOPMENTAL OUTCOME IN TWIN PRETERM INFANTS
Nagamani
Beligere, Dharmapuri Vidyasagar
University of Illinois at Chicago Medical
Center, Department of Pediatrics, Chicago, Illinois, USA
Introduction: Technological advances
in obstetrics with assisted reproduction and neonatology has improved the
survival of low birth weight infants.
The improved survival is accompanied with increase in risk of
cerebral palsy (CP) particularly in twins and multiple gestational births.
Methods
and Materials: We analyzed the data of 40 pairs of twins between 1994-2000, who
were followed in the developmental follow up program at University of
Illinois at Chicago Medical Center.
The gestational age (GA) ranged from 24-32 weeks, birth weight (BW)
540gms<2000 GMS. Apgar score
ranged 5-8 at 5 minutes. Age
at the time of evaluation was 18-24 months. The study consisted of evaluation of infants utilizing
Bailey 11 infant motor development scale and Ameil Tisson neuro
developmental scale, and Goldman Friscott articulation for speech. Infants were evaluated for
retinopathy of prematurely and MRI or CAT scan were done for Gross
developmental delay, the criteria for GP was based on MDI score <70, PDI
score <50, Behavior rating scale >15-20.
Results: 38(47%) infants were
normal, 22 (30%) had mild delay, 8(10%) had CP, five had global delay, and
incidence of CP was higher among the second born twin. Overall outcome of speech delay was
found in (43%) of infants, hearing loss in 6.7% and visual impairment in
10% of these infants. Analysis
of birth weight alone revealed <1000 GM infants had increased incidence
of CP and developmental delay.
50% of the infants suffered respiratory distress (RDS, TTN, BPD),
IVH >grade 11 in (8%), 5% had peri ventricular leukomalacia. 1.7% had seizure disorder and
mental retardation was present in one. Over all growth parameter of height, weight and head
circumference among both first and second born twins at the age of 24
months revealed 35 pairs (95%) of these infants had normal growth
pattern. Only 5% had growth
retardation.
Conclusion: Over all incidence of
CP is higher among twins and triplets. Who was born <1000 GM birth weight compared to single
births suggesting the added influence of twinning and gestational
immaturity, possible prenatal factors?