title: Low maternal age and neonatal survival of extremely preterm twins (20-28 weeks of gestation).
abstract: OBJECTIVE
  We investigated the relationship between low maternal age and neonatal survival among extremely preterm twins.
  
  
  METHODS
  This was a retrospective cohort study on live births of extremely preterm twins delivered to teenaged mothers (aged 15-19 years) in the United States within the period 1995 through 1998. Overall neonatal and early and late neonatal mortality in this category was compared with that of a similar group of twins born to young adult mothers (aged 20-29 years). We used the generalized estimating equation framework in computing relative risks after adjusting for intracluster correlations.
  
  
  RESULTS
  Analysis involved 2,290 extremely preterm liveborn twins of teenaged mothers and 8,709 born to young adult mothers. Overall, neonatal mortality was 29% higher among the extremely preterm twins born to teenaged mothers (adjusted odds ratio [OR] 1.29; 95% confidence interval [CI] 1.04%, 1.59%). The disparity in neonatal survival was chiefly in the early neonatal period (adjusted OR 1.34; 95% CI 1.07%, 1.67%), while late neonatal mortality was comparable (adjusted OR 0.91; 95% CI 0.58%, 1.42%). In addition, twins of teenaged mothers had significantly higher level of mortality, except for the birth weight category of 1,000-1,499 g.
  
  
  CONCLUSIONS
  Low maternal age was found to be associated with elevated risk of neonatal death among extremely preterm twins. The preponderance of deaths among extremely preterm twins of teenaged mothers in the early neonatal period appeared to be responsible for the disparity in survival. This information may be useful for targeted interventions aimed at enhancing survival of extremely preterm twins born to teenagers, as well as for instituting optimal management options in the clinical setting.
  
  
  METHODS
  II-2
authors.affiliation: Department of Maternal and Child Health, University of Alabama at Birmingham, 1665 University Boulevard, Room 320, Birmingham, AL 35294, USA. hsalihu@uab.edu
authors.forename: Hamisu M
authors.initials: HM
authors.lastname: Salihu
authors.forename: Donath
authors.initials: D
authors.lastname: Emusu
authors.forename: Muktar H
authors.initials: MH
authors.lastname: Aliyu
authors.forename: Russell S
authors.initials: RS
authors.lastname: Kirby
authors.forename: Greg R
authors.initials: GR
authors.lastname: Alexander
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D008423:Maternal Age; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011272:Pregnancy, Multiple; D012189:Retrospective Studies; D012306:Risk; D014427:Twins; D014481:United States / Q000453:epidemiology