Neurodevelopmental outcome of preterm twins at 5 years of age

Prevalence and determinants of suspected developmental delays among 12-month-old children in northeast of Iran: a large-scale population-based study

BACKGROUND

Early identification of suspected developmental delays (SDDs) is crucial for planning early interventions. This study aimed to determine the prevalence of SDDs and the associated determinants in children aged 12 months in the northeast of Iran, using the Age and Stage Questionnaire-3 (ASQ-3) as the evaluative tool.

METHODS

This study conducted an analytical cross-sectional design to investigate all children who had completed the ASQ-3 screening form at 12 months of age within the time frame of 2016-2023 in the northeast of Iran. The necessary data were extracted from the electronic health record database associated with Mashhad University of Medical Sciences. To examine the factors associated with SDDs within each domain of the ASQ-3, a multiple logistic regression model was employed, and the results were presented using ORs along with 95% CIs.

RESULTS

Over 7 years, 236 476 children (96.74%) underwent routine ASQ-3 screening at 12 months. After excluding certain cases, 226 076 children (95.60%) were included. Among them, 51 593 children (22.82%) had a score below -1 SD, indicating SDD prevalence in at least one domain. The social-personal domain had the highest prevalence with 22 980 children (10.16%), while the gross motor domain had the lowest with 5650 children (2.50%). Logistic regression analysis identified strong predictors of SDDs, including hospitalisation at birth (OR=1.85, 95% CI:1.69 to 2.02), prematurity (OR=1.56, 95% CI: 1.37 to 1.79), urbanisation (OR=1.51, 95% CI: 1.45 to 1.57), boys (OR=1.36, 95% CI: 1.31 to 1.40) and lack of exclusive breast feeding until 6 months (OR=1.30, 95% CI: 1.25 to 1.34).

CONCLUSION

The prevalence of SDDs highlights the urgency for prompt action, while considering contributing factors. Policymakers can address modifiable risk factors associated with SDDs, including urbanisation risks, support programmes for immigrant families and the importance of exclusive breast feeding until 6 months. Additionally, it is recommended establishing gender-specific local standard cut-off points for the ASQ.

Neonatal and Early Childhood Outcomes of Twin and Singleton Infants Born Preterm

OBJECTIVE

To compare neonatal and early-childhood outcomes of twins and singletons born preterm and explore the association of chorionicity with outcomes.

STUDY DESIGN

This was a national retrospective cohort study of singleton and twin infants admitted at 230/7-286/7 weeks to level III neonatal intensive care units in Canada (2010-2020). The primary neonatal outcome was a composite of neonatal death or severe neonatal morbidities. The primary early-childhood outcome was a composite of death or significant neurodevelopmental impairment.

RESULTS

The study cohort included 3554 twin and 12 815 singleton infants. Twin infants born at 230/7-256/7 weeks had a greater risk of the composite neonatal outcome (adjusted risk ratio 1.04, 95% CI 1.01-1.07). However, these differences were limited to the subgroups of same-sex and monochorionic twin pregnancies. Twin infants of 230/7-256/7 weeks were also at an increased risk of the composite early-childhood outcome (adjusted risk ratio 1.22, 95% CI 1.09-1.37). Twin infants of 260/7-286/7 weeks were not at an increased risk of adverse neonatal outcomes or the composite early-childhood outcome compared with singleton infants.

CONCLUSIONS

Among infants born at 230/7-256/7 weeks, twins have a greater risk of adverse neonatal outcomes and the composite early-childhood outcome than singleton infants. However, the increased risk of adverse neonatal outcomes is mostly limited to monochorionic twins and may thus be driven by complications related to monochorionic placentation.

To be born twin: effects on long-term neurodevelopment of very preterm infants-a cohort study

Objective

To examine the effect of twin birth on long-term neurodevelopmental outcomes in a cohort of Italian preterm infants with very low birth weight.

Study design

We performed a retrospective cohort study on children born in a tertiary care centre. We included children born between 1 January 2007 and 31 December 2013 with a gestational age (GA) of ≤32 weeks and birth weight of <1,500 g. The infants born from twin pregnancies complicated by twin-to-twin transfusion syndrome and from higher-order multiple pregnancies were excluded. The children were evaluated both at 2 years corrected age and 5 years chronological age with Griffiths mental development scales revised (GMDS-R). The linear mixed effects models were used to study the effect of being a twin vs. being a singleton on GMDS-R scores, adjusting for GA, being born small for gestational age, sex, length of NICU stay, socio-economic status, and comorbidity score (CS) calculated as the sum of the weights associated with each of the major morbidities of the infants.

Results

A total of 301 children were included in the study, of which 189 (62.8%) were singletons and 112 (37.2%) were twins; 23 out of 112 twins were monochorionic (MC). No statistically significant differences were observed between twins and singletons in terms of mean general quotient and subscales at both 2 and 5 years. No effect of chorionicity was found when comparing scores of MC and dichorionic twins vs. singletons; however, after adjusting for the CS, the MC twins showed lower scores in the hearing and language and performance subscales at 5 years.

Conclusion

Overall, in our cohort of children born very preterm, twin infants were not at higher risk of neurodevelopmental impairment compared with singletons at pre-school age.

Mild neonatal morbidity in twins by planned mode of delivery: a secondary analysis of the Twin Birth Study

BACKGROUND

The Twin Birth Study showed no differences in major severe adverse neonatal outcomes between those with planned vaginal delivery and those with planned cesarean delivery.

OBJECTIVE

This was a secondary analysis of the Twin Birth Study in which mild neonatal morbidities, not previously reported, were compared between parturients with planned cesarean deliveries and those with planned vaginal delivery in twin births.

STUDY DESIGN

This was a secondary analysis of the Twin Birth Study. In this study, women with a twin pregnancy at 32+0/7 to 38+6/7 weeks of gestation with the first twin in cephalic presentation and with an estimated weight between 1500 and 4000 g were randomized to either planned cesarean delivery or planned vaginal delivery. The primary outcome of this study was a composite mild neonatal outcome of respiratory and neurologic morbidities and neonatal intensive care unit admission that were not reported in the original Twin Birth Study at 34+0/7 to 38+6/7 weeks of gestation. A multivariable logistic regression analysis was used to identify factors associated with the composite adverse neonatal outcomes. Neonatal outcomes were further stratified by gestational age at delivery and by actual mode of delivery.

RESULTS

A total of 1304 women and 1326 women were randomly assigned to planned cesarean delivery and planned vaginal delivery, respectively. Demographic and obstetrical characteristics were similar between the study groups. The rate of cesarean delivery was 90.1% in the planned cesarean delivery group and 40.1% in the planned vaginal delivery group. There was no significant difference in the primary composite outcome between the groups (10.6% vs 11.3%; P=.45) neither by planned mode of delivery nor by actual mode of delivery. Stratification by gestational age found a lower rate of the primary outcomes at ≥38+0/7 weeks of gestation in the planned cesarean delivery group when compared with the planned vaginal delivery group (4.8% vs 10.8%, respectively; P=.02). Furthermore, a lower risk for some individual outcomes was reported in the planned cesarean delivery group when compared with the planned vaginal delivery group, including intraventricular hemorrhage stage 1 to 2 (0.2% vs 0.6%; P<.05), low Apgar scores (0.8% vs 2.3%; P<.05), pH <7.0 (0.3 vs 1%; P<.05), and assisted ventilation needed at delivery (0.4% vs 0.9%; P<.05).

CONCLUSION

In twin deliveries, with the first twin in the cephalic presentation, composite mild neonatal morbidity was not affected by the planned mode of delivery. These findings reinforce the original results of the Twin Birth Study. Nevertheless, an increased composite outcome after 38 weeks' gestation and a higher risk for some individual morbidities in the planned vaginal delivery group might be viewed as a concerning signal for the safety of vaginal delivery in twin deliveries and requires further research.

Association of perinatal factors with suspected developmental delay in urban children aged 1-36 months - a large-scale cross-sectional study in China

BACKGROUND

Studies on perinatal risk factors and the developmental delay of children have been inconclusive and few studies have assessed the association between infants and toddlers' body mass index (BMI) and developmental outcomes.

METHODS

We conducted a cross-sectional study of children aged 1-36 months who had a routine physical examination in the child health departments of hospitals from March 2018 to November 2021 in 16 provinces, 4 autonomous regions and 2 municipalities directly under the central government by using the Infant Toddler Growth Development Screening Test (ITGDST). Normal children were defined as those with scores ≥ mean - 2 standard deviations (SD), while children with developmental delay were those with scores < mean-2SD in terms of overall development, gross motor, fine motor and language development. Binary logistic regression was used to analyze the risk factors of gross motor, fine motor, language and overall neurodevelopment.

RESULTS

After removing some provinces with a small sample size and children with incomplete data, 178,235 children with 12 complete variables were included in the final analysis. The rate of overall developmental delay was 4.5%, while 12.5% of children had at least one developmental delay aspect. Boys, parity, advanced maternal age, multiple birth, cesarean section, neonatal injury, family heredity history, microcephaly, abnormal BMI at birth and at physical examination after controlling the confounding of other factors had a significant effect on development delay (overall neurodevelopment, gross motor, fine motor or language development). Per capita gross domestic product was a protective factor for the children's neuropsychological development.

CONCLUSIONS

This study reveals significant associations of perinatal factors and BMI with developmental delay in the Chinese children aged 1-36 months, which may be crucial for early intervention.