title: Long-term neurodevelopmental outcome of triplets.
abstract: OBJECTIVE
  To analyze the incidence of neurodevelopmental disabilities in triplets and to find out possible connection between the outcome and perinatal events.
  
  
  METHODS
  Retrospective cohort study of 94 triplets and their outcome at 24-144 months of age correlated with gestational age, birth weight, pregnancy complications, early neonatal period, neonatal cranial ultrasound, period of birth (1985-1995, 1996-2000) and type of antenatal care.
  
  
  RESULTS
  Sixty-two triplets are healthy, 15 suffer cerebral palsy (CP) and 17 minimal cerebral dysfunction (MCD). Adverse outcome correlates significantly with prematurity, low birth weight and maternal age. In multivariate analysis, both cerebral palsy and minor disabilities correlate significantly with early neonatal complications, neonatal cranial ultrasound with later CP (p<0.01), and MCD with preterm rupture of membranes (p=0.047). Children conceived spontaneously do worse than those born after assisted reproduction (p=0.004), those born in the time period 1996-2000 do better than those born before (p=0.021). Seventy-seven percent (77%) of newborns delivered in the time period 1996-2000 and after level 1 antenatal care was introduced, compared with 54% being delivered in the time period before 1996 and with less meticulous types of antenatal care, remain healthy (p=0.015).
  
  
  CONCLUSIONS
  Triplets are still at high risk for long-term neurodevelopmental complications. Stringent perinatal care might appear important determinant of their long-term outcome.
authors.affiliation: Department of Perinatal Medicine, School of Medicine, Petrova 13, 10000 Zagreb, Croatia.
authors.forename: Snjezana
authors.initials: S
authors.lastname: Skrablin
authors.forename: Ivan
authors.initials: I
authors.lastname: Kuvacić
authors.forename: Velimir
authors.initials: V
authors.lastname: Simunić
authors.forename: Katarina
authors.initials: K
authors.lastname: Bosnjak-Nadj
authors.forename: Drzislav
authors.initials: D
authors.lastname: Kalafatić
authors.forename: Vladimir
authors.initials: V
authors.lastname: Banović
mesh_terms: D001724:Birth Weight; D001925:Brain Damage, Chronic / Q000453:epidemiology*; D002547:Cerebral Palsy / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004453:Echoencephalography; D005260:Female; D005307:Fertilization in Vitro; D047109:Fetal Development; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008423:Maternal Age; D011247:Pregnancy; D011248:Pregnancy Complications; D011295:Prenatal Care; D012189:Retrospective Studies; D014310:Triplets / Q000502:physiology*; D016216:Ultrasonography, Prenatal