Differences in Risk Factors and Predictors of Preterm Twin Infants with Bronchopulmonary Dysplasia: A retrospective study

Abstract

Abstract Background To evaluate the differences in clinical characteristics, BPD risk factors and predictors in preterm twin infants. Methods A retrospective, single-centre study was conducted on preterm twins admitted to the neonatal intensive care unit (NICU) of The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from January 2021 to December 2022. Data, including perinatal and critical postpartum data, were collected for twin pairs with gestational age (GA) ≤ 31 weeks and birth weight ≤ 2500 g from clinical medical records, including perinatal data and critical postpartum information. Chi-square or nonparametric tests and multiple logistic regression models were used to analyse significant clinical parameters and characteristics for BPD between the two groups and to compare risk factors, respectively. Results A total of 233 twin infants were included in this study. Among them, 183 pairs had BPD, consisting of 366 twin infants. Among twins with BPD, 184 (50.3%) were discordant, and 182 (49.7%) were in one of the twin pairs with BPD. Extremely low birth weight infants (< 1000 g) and extremely preterm infants (GA < 28 weeks) were typical of twin pairs with both BPD (35.9% and 52.7%), while low birth weight infants (< 2500 g) and very preterm infants (GA > 28 < 31 weeks) were more common in one of the twin pairs with BPD (35 .2% and 86.8%). Preterm infants with a length/height between 25 cm and 35 cm were typically twin pairs with BPD (79.7% vs 20.3%). Among the twin pairs with both BPDs, 94 (51.1%) had a head circumference of 22–26 cm compared with 34 (18.7%). Among the risk factors, asphyxia, PDA, RDS, pulmonary hypertension, ROP, IVH, bloodstream infections, hypothyroidism, and hypoproteinaemia were more prevalent in both pairs of twins with BPD. Among the interventions, HFV, IMV, BiPAP, oxygen therapy, and HFNC therapy had significantly different effects on the two groups. The duration of these interventions also significantly differed between the two groups. Conclusions These data demonstrated that risk factors and predictors of BPD in preterm twins vary in magnitude and severity, particularly in extremely low birth weight infants, extremely preterm infants with smaller head circumferences, and infants with short length/height. The need for mechanical ventilation, duration of ventilation, and medication use increased in pairs of twins with both BPD. Thus, this study adds to the existing knowledge on the early detection of risk factors and stratification of clinical management strategies for preterm twins at the individual level.