title: Growth restriction as a determinant of outcome in preterm discordant twins.
abstract: OBJECTIVE
  To estimate the influence of intrauterine growth restriction (IUGR) on the outcome of preterm discordant twins.
  
  
  METHODS
  Medical records of preterm twins born at 24-34 weeks of gestation between 1995 and 2000 were reviewed. Significant discordancy was defined as more than 15% difference in birth weight. Small for gestational age (SGA) was defined as birth weight less than 10th percentile, according to a twin-adjusted gestational age nomogram. The smaller twins of 96 discordant twin pairs were evaluated. The SGA-discordant group included the smaller twin of a discordant pair who was also SGA (n = 46); the appropriate-for-gestational-age (AGA)-discordant group included the smaller twin of a discordant pair who was appropriate for gestational age (n = 50).
  
  
  RESULTS
  Maternal age, incidence of maternal hypertension, antenatal steroids, and gestational age at delivery were similar between groups. Delivery for suspected fetal compromise complicated significantly more pregnancies in the SGA-discordant group than in the AGA-discordant group (45.6% versus 16%, P = .005), as did respiratory distress syndrome (RDS) (37% versus 8%, P < .05) and intraventricular hemorrhage (21.7% versus 6%, P = .024). Mortality or severe neonatal morbidity (defined as severe RDS, intraventricular hemorrhage grades 3-4, or necrotizing enterocolitis) were significantly higher among neonates in the SGA-discordant group than in the AGA-discordant group (19.5% versus 6%, P = .04). The risk for major morbidity was 7.7-fold greater in the SGA-discordant than in the AGA-discordant group, adjusted for gestational age.
  
  
  CONCLUSIONS
  Growth restriction in preterm discordant twins is associated with a 7.7-fold increased risk for major neonatal morbidity. Therefore, discordant twins with IUGR require closer monitoring than discordant twins without IUGR.
authors.affiliation: Department of Obstetrics and Gynecology, Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer, Israel. yinony@barak-online.net
authors.forename: Yoav
authors.initials: Y
authors.lastname: Yinon
authors.forename: Ram
authors.initials: R
authors.lastname: Mazkereth
authors.forename: Naomi
authors.initials: N
authors.lastname: Rosentzweig
authors.forename: Avital
authors.initials: A
authors.lastname: Jarus-Hakak
authors.forename: Eyal
authors.initials: E
authors.lastname: Schiff
authors.forename: Michal J
authors.initials: MJ
authors.lastname: Simchen
mesh_terms: D004200:Diseases in Twins; D005260:Female; D005317:Fetal Growth Retardation / Q000150:complications / Q000235:genetics*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000209:etiology / Q000235:genetics*; D007236:Infant, Small for Gestational Age; D011247:Pregnancy; D012307:Risk Factors