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      Newborn gender as a predictor of neonatal outcome in mixed gender twins born with very low birth weight

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          Abstract

          Background

          Most studies have revealed that the incidence of morbidity and mortality of preterm male infants is greater than that of preterm female infants. Recently, conflicting outcomes have been reported regarding mixed-gender twins. The aim of this study was to estimate the association between gender and outcome in newborn twins of different gender.

          Methods

          We conducted a retrospective review of mixed-gender twins weighing < 1500 g that were born at Shamir Medical Center (Assaf Harofeh) between the years 1995 and 2016 (158 newborns). The incidence of morbidity and mortality until discharge from the hospital were evaluated while looking at gender differences.

          Results

          No significant differences were found in neonatal mortality or morbidity between females and males from different-gender twins. Even after considering confounding variables (gestational age, birth weight & birth order) in linear and logistic regression models, no significant differences were found between the genders.

          Conclusions

          Our study suggests that there are no significant differences in neonatal mortality or morbidity among different-gender twins. Our results support the need for further studies.

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          Most cited references22

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          Fetal sex and preterm birth: are males at greater risk?

          Béatrice Blondel, Marie-Josèphe Saurel-Cubizolles, Pierre Yves Ancel … (2002)
          The existence of a male excess among preterm births is interesting because it could shed light on the aetiology of preterm birth. Possible mechanisms are greater body weight, increased susceptibility to complications of pregnancy, sex-linked biochemical processes and earlier conception in the fertile cycle. We measured the association between fetal sex and preterm birth in four original datasets, including a cohort of births after IVF, and 20 populations extracted from published birthweight references. The original samples were also analysed by mode of onset. There were more males among preterm and early preterm births than among term births in most populations, including IVF births (odds ratio: 1.09-1.24). No male excess was observed for two cohorts of black births, induced preterm births in the general population, and spontaneous onset births after IVF. The proportion of male births declines with increasing gestation, even when time of conception is known. This male excess appears to be strongest for spontaneous preterm births. Studying the sex ratio of preterm births by medical risk factors may clarify why the male excess is absent in some populations. The possibility that obstetric decision-making affects the sex ratio of indicated births must be considered.
          Article 0 comments Cited 66 times – based on 0 reviews     Review now
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            Preterm male infants need more initial respiratory and circulatory support than female infants.

            E Elsmén, L Hellström-Westas, Tor Hansen (2004)
            The aim of this study was to investigate possible gender-related differences in clinical parameters during the first week of life that could explain the higher morbidity and mortality of preterm male infants. In total, 130 clinical variables were collected from 236 inborn infants (130 male and 106 female infants) with gestational age (GA) < 29 wk. A subgroup of 175 extremely low birthweight infants (ELBW) < 1000 g (n = 86 males; n = 89 females) was analysed separately. At 6 postnatal h, 60.8% of the male infants needed mechanical ventilation versus 46.2% of the females (p = 0.026). Chronic lung disease (CLD) developed in 36.2% of males versus 9.8% of female infants (p = 0.004). Inotrope support with dopamine was used in more than 50% of the infants; additional inotrope support to dopamine was needed by 19.4% of male and 9.7% of female infants (p = 0.041). The gender-related difference in need for inotrope support was more evident among the ELBW infants; 67.1% of male infants needed inotrope support versus 50.6% of females (p = 0.028). At 12-24 h, male ELBW infants had lower minimum mean arterial blood pressure (mean (SD) 25(4) mmHg vs 28(6) mmHg, p = 0.004)) and lower minimum PaCO2 than females infants (4.3 (1.1) kPa vs 4.7 (0.9) kPa, p = 0.043). There are early gender-related differences in need for ventilatory and circulatory support that may contribute to the worse long-term outcome in prematurely born male infants.
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              Neonatal disease severity scoring systems.

              R. Field, J Dorling, B Manktelow (2004)
              Illness severity scores have become widely used in neonatal intensive care. Primarily this has been to adjust the mortality observed in a particular hospital or population for the morbidity of their infants, and hence allow standardised comparisons to be performed. However, although risk correction has become relatively commonplace in relation to audit and research involving groups of infants, the use of such scores in giving prognostic information to parents, about their baby, has been much more limited. The strengths and weaknesses of the existing methods of disease severity correction in the newborn are presented in this review.
              Article 0 comments Cited 44 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Bernard Barzilay: barzilay@shamir.gov.il
                Nina Shirman: ninashirman@gmail.com
                Haim Bibi: bibih@shamir.gov.il
                Ibrahim Abu-Kishk: +972-8-9779104 , ibrahima@shamir.gov.il
                Journal
                Journal ID (nlm-ta): BMC Pediatr
                Journal ID (iso-abbrev): BMC Pediatr
                Title: BMC Pediatrics
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2431
                Publication date (Electronic): 11 September 2019
                Publication date PMC-release: 11 September 2019
                Publication date Collection: 2019
                Volume: 19
                Electronic Location Identifier: 328
                Affiliations
                [1 ]ISNI 0000 0004 1937 0546, GRID grid.12136.37, Neonatal Intensive Care Unit, Shamir Medical Center (Assaf Harofeh), Zerifin, affiliated to the Sackler Faculty of Medicine, , Tel-Aviv University, ; Tel-Aviv, Israel
                [2 ]ISNI 0000 0004 1937 0546, GRID grid.12136.37, Pediatric Intensive Care Unit, Shamir Medical Center (Assaf Harofeh), Zerifin, affiliated to the Sackler Faculty of Medicine, , Tel-Aviv University, ; Tel-Aviv, Israel
                [3 ]Pediatric Division, Shamir Medical Center (Assaf Harofeh), 7033001 Zerifin, Israel
                Article
                Publisher ID: 1713
                DOI: 10.1186/s12887-019-1713-2
                PMC ID: 6737713
                PubMed ID: 31510951
                SO-VID: 410ac80e-06f2-4322-857b-7a632ca970b1
                Copyright © © The Author(s). 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 11 April 2019
                Date accepted : 6 September 2019
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Pediatrics
                Keywords: twins,gender,very low birth weight,neonatal morbidity,neonatal mortality
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: twins, gender, very low birth weight, neonatal morbidity, neonatal mortality

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