Archives of disease in childhood. Fetal and neonatal edition · 2020
Neonatal outcomes of extremely preterm twins by sex pairing: an international cohort study.
СтатьяНазвание и аннотация: Перевод в очереди
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Gagliardi Luigi, Rusconi Franca, Reichman Brian, Adams Mark, Modi Neena, Lehtonen Liisa, Kusuda Satoshi, Vento Maximo, Darlow Brian A, Bassler Dirk, Isayama Tetsuya, Norman Mikael, Håkansson Stellan, Lee Shoo K, Lui Kei, Yang Junmin, Shah Prakeshkumar, International Network for Evaluating Outcomes of Neonates (iNeo) Investigators
Аннотация
OBJECTIVE: Infant boys have worse outcomes than girls. In twins, the 'male disadvantage' has been reported to extend to female co-twins via a 'masculinising' effect. We studied the association between sex pairing and neonatal outcomes in extremely preterm twins.
DESIGN: Retrospective cohort study SETTING: Eleven countries participating in the International Network for Evaluating Outcomes of Neonates.
PATIENTS: Liveborn twins admitted at 23-29 weeks' gestation in 2007-2015.
MAIN OUTCOME MEASURES: We examined in-hospital mortality, grades 3/4 intraventricular haemorrhage or cystic periventricular leukomalacia (IVH/PVL), bronchopulmonary dysplasia (BPD), retinopathy of prematurity requiring treatment and a composite outcome (mortality or any of the outcomes above).
RESULTS: Among 20 924 twins, 38% were from male-male pairs, 32% were from female-female pairs and 30% were sex discordant. We had no information on chorionicity. Girls with a male co-twin had lower odds of mortality, IVH/PVL and the composite outcome than girl-girl pairs (reference group): adjusted OR (aOR) (95% CI) 0.79 (0.68 to 0.92), 0.83 (0.72 to 0.96) and 0.88 (0.79 to 0.98), respectively. Boys with a female co-twin also had lower odds of mortality: aOR 0.86 (0.74 to 0.99). Boys from male-male pairs had highest odds of BPD and composite outcome: aOR 1.38 (1.24 to 1.52) and 1.27 (1.16 to 1.39), respectively.
CONCLUSIONS: Sex-related disparities in outcomes exist in extremely preterm twins, with girls having lower risks than boys and opposite-sex pairs having lower risks than same-sex pairs. Our results may help clinicians in assessing risk in this large segment of extremely preterm infants.
DESIGN: Retrospective cohort study SETTING: Eleven countries participating in the International Network for Evaluating Outcomes of Neonates.
PATIENTS: Liveborn twins admitted at 23-29 weeks' gestation in 2007-2015.
MAIN OUTCOME MEASURES: We examined in-hospital mortality, grades 3/4 intraventricular haemorrhage or cystic periventricular leukomalacia (IVH/PVL), bronchopulmonary dysplasia (BPD), retinopathy of prematurity requiring treatment and a composite outcome (mortality or any of the outcomes above).
RESULTS: Among 20 924 twins, 38% were from male-male pairs, 32% were from female-female pairs and 30% were sex discordant. We had no information on chorionicity. Girls with a male co-twin had lower odds of mortality, IVH/PVL and the composite outcome than girl-girl pairs (reference group): adjusted OR (aOR) (95% CI) 0.79 (0.68 to 0.92), 0.83 (0.72 to 0.96) and 0.88 (0.79 to 0.98), respectively. Boys with a female co-twin also had lower odds of mortality: aOR 0.86 (0.74 to 0.99). Boys from male-male pairs had highest odds of BPD and composite outcome: aOR 1.38 (1.24 to 1.52) and 1.27 (1.16 to 1.39), respectively.
CONCLUSIONS: Sex-related disparities in outcomes exist in extremely preterm twins, with girls having lower risks than boys and opposite-sex pairs having lower risks than same-sex pairs. Our results may help clinicians in assessing risk in this large segment of extremely preterm infants.
Предметные рубрики MeSH
Bronchopulmonary DysplasiaCerebral Intraventricular HemorrhageDeveloped CountriesFemaleGestational AgeHospital MortalityHumansInfant, Extremely PrematureInfant, NewbornInfant, Premature, DiseasesInfant, Very Low Birth WeightLeukomalacia, PeriventricularMaleRetinopathy of PrematurityRetrospective StudiesSeverity of Illness IndexSex FactorsTwins