Fetal or infant death in twin pregnancy: neurodevelopmental consequence for the survivor

• Published in: Archives of disease in childhood. Fetal and neonatal edition Vol. 86; no. 1; pp. F9 - F15
• Main Authors: Glinianaia, S V, Pharoah, P O D, Wright, C, Rankin, J M
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.01.2002; BMJ; BMJ Publishing Group LTD; National Library of Medicine - MEDLINE Abstracts
• Subjects: Age; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Babies; Biological and medical sciences; Brain Diseases - embryology; Brain Diseases - epidemiology; Brain Diseases - etiology; Cause of Death; Cerebral palsy; Cerebral Palsy - embryology; Cerebral Palsy - epidemiology; Cerebral Palsy - etiology; Children & youth; Collaboration; confidence interval; Confidence intervals; Disability; Diseases in Twins - embryology; Diseases in Twins - epidemiology; Diseases in Twins - etiology; Diseases of mother, fetus and pregnancy; Emergency and intensive care: neonates and children. Prematurity. Sudden death; England - epidemiology; Ethics; Female; Fetal Death; Fetofetal Transfusion - complications; Follow-Up Studies; Gestational Age; Gynecology. Andrology. Obstetrics; Humans; Infant Mortality; Infant, Newborn; Intensive care medicine; Male; Medical sciences; Morbidity; Mortality; Northern Perinatal Mortality Survey; Original; PMS; Population; Pregnancy; Pregnancy. Fetus. Placenta; Premature birth; Prevalence; Questionnaires; Risk Factors; Sex Factors; Studies; twin-twin transfusion; Twins; England; Human; Death; Infant; Survivor; Twin pregnancy
• ISSN: 1359-2998; 1468-2052
• DOI: 10.1136/fn.86.1.F9

Aim: To determine the neurodevelopmental morbidity in the surviving twin after fetal or infant death of the co-twin. Methods: Twin pregnancies with an antepartum or infant death delivered between 1981 and 1992 were identified from the Northern Perinatal Mortality Survey. Information on the neurodevelopmental morbidity of infant survivors of a deceased co-twin was obtained by a questionnaire sent to the community paediatrician or general practitioner. Results: A total of 111 children who survived infancy after the fetal death of the co-twin (group 1) and 142 from liveborn twin pairs in which one twin died in infancy (group 2) were traced. Responses were received from 97 (87%) and 130 (92%) respectively. In group 1, the cerebral palsy prevalence was 93 (95% confidence interval (CI) 43 to 169) per 1000 infant survivors; it was more common in like-sex pairs (8/70) with a prevalence of 114 (95% CI 51 to 213) compared with 45 (95% CI 1 to 228) per 1000 infant survivors in unlike-sex pairs (1/22). The overall prevalence of neurodevelopmental morbidity (including developmental delay) was 175 (95% CI 106 to 266) per 1000. In group 2, the cerebral palsy prevalence was 154 (95% CI 84 to 223) per 1000 infant survivors in like-sex (16/104) and 77 (95% CI 9 to 251) in unlike-sex (2/26) survivors; the overall prevalence of neurodevelopmental morbidity was 246 (95% CI 172 to 320) per 1000. Conclusions: The risk of cerebral palsy is increased in the surviving twin after a fetal or infant co-twin death compared with the general twin population. Like-sex twins are at greater risk than unlike-sex. The probable cause, in addition to the consequences of prematurity, is twin-twin transfusion problems associated with monochorionicity.