Mortality and short-term outcomes of preterm infants of multiple versus singleton gestations

Objective: To compare mortality and major neonatal morbidities between singleton preterm infants and preterm infants of multiple gestations born between 23 + 0 to 32 + 6 weeks. Method This is a retrospective cohort study of preterm infants (23 + 0 to 32 + 6 weeks gestational age) born at King Abdul-Aziz Medical City Riyadh (KAMC-R) between January 2016 to December 2020. Results Total of 803 preterm infants were included: 567 (70.6%) were singletons, 158 (19.6%) were twins and 36 (4.5%) infants were triplets and higher multiples. The mortality was significantly higher in preterm infants of multiple gestations compared to singleton (12.3% vs. 7.9%; p = 0.003; OR, 2.2; CI, 1.3–3.7). Preterm infants of multiple gestations had an increased risk of ROP (11% vs. 6.5%; P = 0.033; OR, 1.1, CI, 1.04–2.99), BPD at 36 weeks PMA (29.7% vs. 20.5%; P = 0.003; OR, 1.7; CI, 1.2–2.5) and sepsis (24.2% vs 17.5%, P = 0.044; OR, 1.5; CI, 1.01–2.2) compared to preterm singletons. There were no differences in mortality and adverse neonatal outcomes between twins and higher multiples. Conclusion Preterm infants of multiple gestations suffered higher mortality and neonatal morbidities compared to preterm singleton infants despite a higher utilization of maternal antenatal steroids and better antenatal care.