{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T04:18:23Z","timestamp":1789532303997,"version":"build-2803163510"},"reference-count":29,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:p>Objective\u2003The aim of this study is to compare neonatal mortality and morbidity in multiple and singleton preterm\/very low birthweight (PT\/VLBW) multiethnic Asian infants.<\/jats:p><jats:p>Study Design\u2003Cohort study of 676 singleton and 299 multiple PT\/VLBW infants born between 2008 and 2012 at KK Women's and Children's Hospital, the largest tertiary perinatal center in Singapore with further stratification by gestational ages 23 to 25 (Group 1), 26 to 28 (Group 2), and \u226529 (Group 3) weeks. Outcome measures included predischarge mortality and major neonatal morbidity.<\/jats:p><jats:p>Results\u2003Overall survival to discharge was comparable for singletons 611\/676 (90%) and multiples 273\/299 (91%). Use of assisted reproductive technologies (47 vs. 4%), antenatal steroids (80 vs. 68%), and delivery by cesarean section (84 vs. 62%) were significantly higher (p\u2009&lt;\u20090.001) in multiples while pregnancy induced hypertension (8.7 vs. 31.6%, p\u2009&lt;\u20090.001) and maternal chorioamnionitis (31 vs. 41%, p\u2009&lt;\u20090.01) were seen less commonly compared with singleton pregnancies. Survival was comparable between singletons and multiples except for a lower survival in multiples in Group 2 (81.7 vs. 92.4%, p\u2009=\u20090.007). Major neonatal morbidities were comparable for multiples and singletons in the overall cohort. Presence of hemodynamically significant patent ductus arteriosus (HsPDA) requiring treatment (88.9 vs. 72.5%), air leaks (33 vs. 14.6%, p\u2009=\u20090.02), NEC (30 vs. 14.6%, p\u2009=\u20090.04), and composite morbidity (86 vs. 66%, p\u2009=\u20090.031) were significantly higher in multiples in Group 1. A significantly higher incidence of HsPDA (68.1 vs. 52.4%, p\u2009=\u20090.008) was also observed in multiples in Group 2. Multiple pregnancy was not an independent predictor of an adverse outcome on regression analysis (OR: 0.685, 95% confidence interval: 0.629\u20132.02) even in GA \u226425 weeks.<\/jats:p><jats:p>Conclusion\u2003Neonatal mortality and morbidity were comparable in our cohort of PT\/VLBW singletons and multiple births, but preterm multiple births \u226425 weeks had a higher incidence of neonatal morbidity.<\/jats:p><jats:p>Key Points<\/jats:p>","DOI":"10.1055\/s-0040-1716482","type":"journal-article","created":{"date-parts":[[2020,9,11]],"date-time":"2020-09-11T22:50:12Z","timestamp":1599864612000},"page":"409-415","source":"Crossref","is-referenced-by-count":5,"title":["Single Center Outcome of Multiple Births in the Premature and Very Low Birth Weight Cohort in Singapore"],"prefix":"10.1055","volume":"39","author":[{"given":"Amudha Jayanthi","family":"Anand","sequence":"additional","affiliation":[{"name":"Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore"},{"name":"Department of Paediatrics, Duke NUS Medical School, Singapore, Singapore"},{"name":"Department of Paediatrics, NUS Yong Loo Lin School of Medicine, Singapore, Singapore"},{"name":"Department of Paediatrics, NTU Lee Kong Chian School of medicine, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthik","family":"Sabapathy","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation (PGY4), Penn State Hershey Medical Center, Hummelstown, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhavani","family":"Sriram","sequence":"additional","affiliation":[{"name":"Minds Disabilities Medical Clinic, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor Samuel","family":"Rajadurai","sequence":"additional","affiliation":[{"name":"Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore"},{"name":"Department of Paediatrics, Duke NUS Medical School, Singapore, Singapore"},{"name":"Department of Paediatrics, NUS Yong Loo Lin School of Medicine, Singapore, Singapore"},{"name":"Department of Paediatrics, NTU Lee Kong Chian School of medicine, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pratibha Keshav","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Duke NUS Medical School, Singapore, Singapore"},{"name":"Department of Paediatrics, NUS Yong Loo Lin School of Medicine, Singapore, Singapore"},{"name":"Department of Paediatrics, NTU Lee Kong Chian School of medicine, Singapore"},{"name":"Medical Clinic, MINDS Disabilities, KK Women's and Children's Hospital, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,9,11]]},"reference":[{"issue":"01","key":"ref1","first-page":"129","article-title":"The changing epidemiology of multiple births in the United States","volume":"101","author":"R B Russell","year":"2003","journal-title":"Obstet Gynecol"},{"issue":"08","key":"ref2","first-page":"661","article-title":"The contribution of singletons, twins and triplets to low birth weight, infant mortality and handicap in the United States","volume":"37","author":"B Luke","year":"1992","journal-title":"J Reprod Med"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"586.e1","DOI":"10.1016\/j.ajog.2013.10.005","article-title":"Healthcare expenses associated with multiple vs singleton pregnancies in the United States","volume":"209","author":"E V Lemos","year":"2013","journal-title":"Am J Obstet Gynecol"},{"issue":"08","key":"ref5","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.2105\/AJPH.92.8.1323","article-title":"The impact of the increasing number of multiple births on the rates of preterm birth and low birthweight: an international study","volume":"92","author":"B Blondel","year":"2002","journal-title":"Am J Public Health"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/0029-7844(94)00455-M","article-title":"The origin and outcome of preterm twin pregnancies","volume":"85","author":"M O Gardner","year":"1995","journal-title":"Obstet Gynecol"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1186\/1742-4755-10-S1-S2","article-title":"Born too soon: the global epidemiology of 15 million preterm births","volume":"10","author":"H Blencowe","year":"2013","journal-title":"Reprod Health"},{"issue":"06","key":"ref8","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1055\/s-2007-981852","article-title":"Very-low-birthweight neonates: do outcomes differ in multiple compared with singleton gestations?","volume":"24","author":"E J Hayes","year":"2007","journal-title":"Am J Perinatol"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1016\/j.ajog.2004.03.040","article-title":"Twins and triplets: the effect of plurality and growth on neonatal outcome compared with singleton infants","volume":"191","author":"T J Garite","year":"2004","journal-title":"Am J Obstet Gynecol"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1053\/siny.2002.0107","article-title":"Neonatal and long-term outcomes of very low birth weight infants from single and multiple pregnancies","volume":"7","author":"E S Shinwell","year":"2002","journal-title":"Semin Neonatol"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1542\/peds.2014-4075","article-title":"Trends in morbidity and mortality of extremely preterm multiple gestation newborns","volume":"136","author":"K T Yeo","year":"2015","journal-title":"Pediatrics"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/1471-2431-13-59","article-title":"A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants","volume":"13","author":"T R Fenton","year":"2013","journal-title":"BMC Pediatr"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/S0022-3476(83)80366-7","article-title":"Relationship of cerebral intraventricular hemorrhage and early childhood neurological handicaps","volume":"103","author":"L A Papile","year":"1983","journal-title":"J Pediatr"},{"issue":"01","key":"ref15","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1542\/peds.93.1.32","article-title":"Clinical comparison of localized intestinal perforation and necrotizing enterocolitis in neonates","volume":"93","author":"J Q Buchheit","year":"1994","journal-title":"Pediatrics"},{"issue":"08","key":"ref16","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1038\/jp.2015.41","article-title":"Intestinal perforation in very preterm neonates: risk factors and outcomes","volume":"35","author":"J Shah","year":"2015","journal-title":"J Perinatol"},{"issue":"07","key":"ref17","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1001\/archopht.123.7.991","article-title":"The International Classification of Retinopathy of Prematurity revisited","volume":"123","author":"International Committee for the Classification of Retinopathy of Prematurity","year":"2005","journal-title":"Arch Ophthalmol"},{"issue":"03","key":"ref18","first-page":"131","article-title":"Pre-discharge outcomes of 22-27 weeks gestational age infants born at tertiary care centers in Connecticut implications for perinatal management","volume":"62","author":"N Hussain","year":"1998","journal-title":"Conn Med"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1542\/peds.2008-0377","article-title":"Using a count of neonatal morbidities to predict poor outcome in extremely low birth weight infants: added role of neonatal infection","volume":"123","author":"D Bassler","year":"2009","journal-title":"Pediatrics"},{"issue":"02","key":"ref20","doi-asserted-by":"crossref","first-page":"F128","DOI":"10.1136\/adc.2003.046268","article-title":"Changes in mortality and morbidities among infants born at less than 25 weeks during the post-surfactant era","volume":"90","author":"S R Hintz","year":"2005","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"09","key":"ref21","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1001\/jama.289.9.1124","article-title":"Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months: results from the trial of indomethacin prophylaxis in preterms","volume":"289","author":"B Schmidt","year":"2003","journal-title":"JAMA"},{"issue":"11","key":"ref22","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1001\/jamapediatrics.2014.1357","article-title":"Hospital costs of multiple-birth and singleton-birth children during the first 5 years of life and the role of assisted reproductive technology","volume":"168","author":"G M Chambers","year":"2014","journal-title":"JAMA Pediatr"},{"issue":"06","key":"ref23","doi-asserted-by":"crossref","first-page":"779","DOI":"10.3346\/jkms.2003.18.6.779","article-title":"Comparison of mortality and morbidity in multiple versus singleton very low birth weight infants in a neonatal intensive care unit","volume":"18","author":"K H Lee","year":"2003","journal-title":"J Korean Med Sci"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/S0002-9378(97)70160-1","article-title":"Stephen Hung, MD. Boston Massachusetts Neonatal outcomes of very premature infants from multiple and singleton gestations","volume":"177","author":"H C Nielson","year":"1997","journal-title":"Am J Obstet Gynecol"},{"issue":"02","key":"ref25","first-page":"241","article-title":"Is there difference in perinatal outcome of singleton and twin pregnancies after assisted conception: two-year experience","volume":"52","author":"M Vuli\u0107","year":"2013","journal-title":"Acta Clin Croat"},{"issue":"01","key":"ref26","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.rbmo.2017.09.009","article-title":"Perinatal outcomes after stimulated versus natural cycle IVF: a systematic review and meta-analysis","volume":"36","author":"M S Kamath","year":"2018","journal-title":"Reprod Biomed Online"},{"issue":"04","key":"ref27","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1093\/humrep\/dei419","article-title":"Perinatal outcome of 12,021 singleton and 3108 twin births after non-IVF-assisted reproduction: a cohort study","volume":"21","author":"W Ombelet","year":"2006","journal-title":"Hum Reprod"},{"issue":"04","key":"ref28","first-page":"381","article-title":"Neonatal outcomes of preterm or very-low-birth-weight infants over a decade from Queen Mary Hospital, Hong Kong: comparison with the Vermont Oxford Network","volume":"23","author":"Y Y Chee","year":"2017","journal-title":"Hong Kong Med J"},{"key":"ref29","first-page":"1","article-title":"Morbidity and mortality of very low birth weight multiples compared with singletons","author":"R Porta","year":"2017","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"07","key":"ref30","doi-asserted-by":"crossref","first-page":"328","DOI":"10.47102\/annals-acadmedsg.V42N7p328","article-title":"Borderline viability--neonatal outcomes of infants in Singapore over a period of 18 years (1990\u20132007)","volume":"42","author":"P Agarwal","year":"2013","journal-title":"Ann Acad Med Singapore"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1016\/S0022-3476(05)82015-3","article-title":"Perinatal outcomes of a large cohort of extremely low gestational age infants (twenty-three to twenty-eight completed weeks of gestation)","volume":"125","author":"A R Synnes","year":"1994","journal-title":"J Pediatr"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0040-1716482.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,7]],"date-time":"2023-10-07T07:00:25Z","timestamp":1696662025000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0040-1716482"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,11]]},"references-count":29,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2022,2,25]]},"published-print":{"date-parts":[[2022,3]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0040-1716482","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,11]]}}}