Perinatology.  2024 Jun;35(2):61-68. 10.14734/PN.2024.35.2.61.

Growth and Developmental Outcomes of Triplets Preterm Infants according to the Chorionicity: A Retrospective Cohort Study

• Nam EW
• Ryu JH
• Hwang HS
• Choi HJ
• Park S
• Shin SH
• Kim EK
• Kim HS

• KMID: 2557570
• DOI: http://doi.org/10.14734/PN.2024.35.2.61

Abstract

Objective
We elucidated the effect of monochorionicity on neonatal and long-term neurologic outcomes on an individual basis in triplets.
Methods
We retrospectively reviewed the perinatal outcomes and development and growth at 18 to 24 months corrected age (CA) of triplets born alive between 24 and 32 weeks of gestational age (GA) between 2009 and 2021 from the Seoul National University Hospital database. Neurod­evelopmental impairment (NDI) was defined as any delay among the Bayley-III domains (motor and language), cerebral palsy, hearing impairment, or visual loss and was performed at a CA of 18 to 24 months.
Results
We included 40 sets of triplets (120 infants), comprising 26, 10, and 4 sets of trichorionic (TC), dichorionic (DC), and monochorionic (MC) triplets, respectively. Ten infants, unaffected by monochorionicity out of 30 DC infants, were included in the non-MC group. Eighty-eight infants were included in the non-MC group, and 32 infants were affected by monochorionicity. In vitro fertilization-embryo transfer was more frequent in the non-MC group (P<0.05), and twin-to-twin transfusion syndrome affected only the MC group (P<0.01). At 24 months of CA, a combined delay of language and cognition in Bayley-III was evident in the MC group (P<0.05). Although NDI did not significantly differ between the 2 groups (P=0.059), the composite outcome of NDI+ postnatal death was significantly different (P<0.05). NDI+ postnatal death correlated with GA, Z-score of birth weight, brain injury, and monochorionicity in the univariate analysis (P<0.05). Multivariate analysis revealed a significant correlation between monochorionicity and NDI+ postnatal death. (P<0.05).
Conclusion
Monochorionicity is associated with adverse long-term neurodevelopmental out comes.

Keyword

Infant; premature; Triplets; Growth and development