Seung Mi Lee1, Byoung Jae Kim1,2, Joong Shin Park1, Errol R Norwitz3, Jeong Won Oh1, Sohee Oh4, Chanthalakeo Vixay5, Sun Min Kim1,2, Chan-Wook Park1, Jong Kwan Jun1. 1. Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea. 2. Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea. 3. Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA, USA. 4. Department of Biostatistics, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea. 5. Department of Obstetrics and Gynecology, University of Health Sciences, Vientiane, Lao People's Democratic Republic.
Abstract
Objective: Prior studies have suggested that nonpresenting twins are more likely to develop respiratory distress syndrome (RDS) than presenting twins. While the underlying mechanism is not known, exposure to intra-amniotic infection/inflammation (IAI) has been associated with a reduced risk of RDS in singleton gestations. In the current study, we compared the risk of RDS in preterm twin neonates according to birth order with adjustment for the presence or absence of IAI. Methods: The study population consisted of consecutive twin neonates who delivered ≤35 weeks and underwent amniocentesis within 7 days of delivery. The frequency of RDS and IAI was compared between presenting and nonpresenting twin pairs. Amniotic fluid (AF) was cultured for aerobic/anaerobic bacteria and genital mycoplasma. IAI was defined as a positive AF culture or an AF white cell count ≥19/mm3. Results: A total of 120 twin pairs were enrolled. Compared with presenting twins, nonpresenting twins had a lower risk of IAI (36 vs. 26%, respectively, p < .05), but a higher risk of RDS (18 vs. 25%, respectively, p < .05). In multivariate analysis, only IAI remained significantly associated with RDS (OR 0.18, 95% CI 0.05-0.65), whereas birth order was not.Conclusions: In preterm twin neonates, the increased risk of RDS in nonpresenting twins is likely due to lower exposure to IAI and not birth order.
Objective: Prior studies have suggested that nonpresenting twins are more likely to develop respiratory distress syndrome (RDS) than presenting twins. While the underlying mechanism is not known, exposure to intra-amniotic infection/inflammation (IAI) has been associated with a reduced risk of RDS in singleton gestations. In the current study, we compared the risk of RDS in preterm twin neonates according to birth order with adjustment for the presence or absence of IAI. Methods: The study population consisted of consecutive twin neonates who delivered ≤35 weeks and underwent amniocentesis within 7 days of delivery. The frequency of RDS and IAI was compared between presenting and nonpresenting twin pairs. Amniotic fluid (AF) was cultured for aerobic/anaerobic bacteria and genital mycoplasma. IAI was defined as a positive AF culture or an AF white cell count ≥19/mm3. Results: A total of 120 twin pairs were enrolled. Compared with presenting twins, nonpresenting twins had a lower risk of IAI (36 vs. 26%, respectively, p < .05), but a higher risk of RDS (18 vs. 25%, respectively, p < .05). In multivariate analysis, only IAI remained significantly associated with RDS (OR 0.18, 95% CI 0.05-0.65), whereas birth order was not.Conclusions: In preterm twin neonates, the increased risk of RDS in nonpresenting twins is likely due to lower exposure to IAI and not birth order.
Authors: Hassendrini N Peiris; Roberto Romero; Kanchan Vaswani; Sarah Reed; Nardhy Gomez-Lopez; Adi L Tarca; Dereje W Gudicha; Offer Erez; Eli Maymon; Murray D Mitchell Journal: J Matern Fetal Neonatal Med Date: 2019-12-29