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Assessment of different thresholds of birthweight discordance in early neonatal outcomes among twins: analysis of a seven-year retrospective cohort
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  • Dongxin Lin,
  • Dazhi Fan,
  • Pengsheng Li,
  • Gengdong Chen,
  • Shuzhen Wu,
  • Shaoxin Ye,
  • Huiting Ma,
  • Huishan Zhang,
  • Jiaming Rao,
  • Ting Chen,
  • Meng Zeng,
  • Xiaoling Guo,
  • Zhengping Liu
Dongxin Lin
Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan
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Dazhi Fan
Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan
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Pengsheng Li
Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan
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Gengdong Chen
Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan
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Shuzhen Wu
Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan
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Shaoxin Ye
Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan
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Huiting Ma
Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan
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Huishan Zhang
Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan
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Jiaming Rao
Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan
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Ting Chen
Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan
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Meng Zeng
Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan
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Xiaoling Guo
Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan
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Zhengping Liu
Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan
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Abstract

Objective: To evaluate the thresholds of BWD for predicting early neonatal outcomes and assess the predictive accuracy of BWD. Design: Retrospective cohort study. Setting: Single Chinese University Hospital. Population: All women with liveborn twins at gestational age of ≥ 26 weeks. Methods: Multivariable logistic regression analyses of association between neonatal outcomes and BWD with different thresholds (≥15.0%, ≥20.0%, ≥25% and ≥30%). Generalized estimated equation (GEE) models to address inter-twin correlation. Restrictive cubic spline (RCS) models to draw the dose-response relationship. Clustered receiver operating characteristic (ROC) curve analysis to assess the predictive accuracy. Main outcomes: NICU admission, neonatal respiratory distress syndrome (NRDS), ventilator support and composite outcome including major morbidity and neonatal death. Results Among 2348 twin pairs, BWD were at significantly increased risks of NICU admission, irrespective of the thresholds. The risks of NRDS, ventilator support and composite outcome were significantly higher when a threshold of ≥20% or above was chosen. The dose-response relationship showed non-linear growth in risk of adverse neonatal outcomes with the increasing BWD. ROC analyses showed a low significant AUROC of 0.569 (95% CI: 0.526-0.612) for predicting NICU admission but no significant AUROC for predicting other outcomes. A BWD of ≥30% provided a moderate increase in the likelihood of NICU admission [positive likelihood ratio (LR+) =5.77]. Conclusions BWD is independently associated with adverse neonatal outcomes. Regardless of this association, BWD could not serve as a single predictor for neonatal outcomes. A cut-off of 30% is more practical for risk stratification among twin gestations.