Predictors of in-hospital mortality in newborn conjoined twins.
Abnormalities, Multiple
/ mortality
Female
Gestational Age
Hospital Mortality
Hospitals, Pediatric
/ statistics & numerical data
Humans
Incidence
Infant, Low Birth Weight
Infant, Newborn
Infant, Premature
Male
Retrospective Studies
Risk Factors
Sex Factors
Twins, Conjoined
United States
/ epidemiology
Journal
Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
21
01
2019
revised:
15
06
2019
accepted:
25
06
2019
pubmed:
14
8
2019
medline:
25
2
2020
entrez:
13
8
2019
Statut:
ppublish
Résumé
Conjoined twins are rare developmental anomalies. There is a paucity of literature other than case reports and small case series. The aim of this study was to examine national outcomes and identify predictors of mortality in newborn conjoined twins. We reviewed data on newborn conjoined twins from the Kids' Inpatient Database (1997-2012). A total of 240 patients were identified for a nationally weighted incidence of 1 per 100,000 live births. The majority of conjoined twins were female (n = 190 [81%]). The most commonly associated anomalies were cardiac (n = 87 [36%]), gastrointestinal (n = 41 [17%]), and abdominal wall (n = 32 [13%]) defects. Fifty-six (23%) patients underwent operative procedures, including 28 (12%) neonatal separation surgeries. The overall mortality rate was 61%; most deaths occurred within 24 hours (99 of 146 [68%]) to 48 hours (129 of 146 [88%]) after birth. Mortality was higher in female compared with male children (66% vs 38%, P = .025), premature compared with full-term children (72% vs 44%, P = .007), and in children with extremely low birth weight (95% vs 59%, P = .002). Congenital diaphragmatic hernias were seen in 15 (6%) patients and were uniformly fatal (100% vs 58%, P = .029). Mortality was highest in hospitals not designated as children's hospitals (72%) compared with children's hospitals (44%) (P = .007). Conjoined twins are rare anomalies who are susceptible to extremely high perinatal mortality, especially in female children, those who are premature, or those who have low birth weight. These data support caring for these complex patients at hospitals equipped to care for this fragile population.
Sections du résumé
BACKGROUND
Conjoined twins are rare developmental anomalies. There is a paucity of literature other than case reports and small case series. The aim of this study was to examine national outcomes and identify predictors of mortality in newborn conjoined twins.
METHODS
We reviewed data on newborn conjoined twins from the Kids' Inpatient Database (1997-2012).
RESULTS
A total of 240 patients were identified for a nationally weighted incidence of 1 per 100,000 live births. The majority of conjoined twins were female (n = 190 [81%]). The most commonly associated anomalies were cardiac (n = 87 [36%]), gastrointestinal (n = 41 [17%]), and abdominal wall (n = 32 [13%]) defects. Fifty-six (23%) patients underwent operative procedures, including 28 (12%) neonatal separation surgeries. The overall mortality rate was 61%; most deaths occurred within 24 hours (99 of 146 [68%]) to 48 hours (129 of 146 [88%]) after birth. Mortality was higher in female compared with male children (66% vs 38%, P = .025), premature compared with full-term children (72% vs 44%, P = .007), and in children with extremely low birth weight (95% vs 59%, P = .002). Congenital diaphragmatic hernias were seen in 15 (6%) patients and were uniformly fatal (100% vs 58%, P = .029). Mortality was highest in hospitals not designated as children's hospitals (72%) compared with children's hospitals (44%) (P = .007).
CONCLUSION
Conjoined twins are rare anomalies who are susceptible to extremely high perinatal mortality, especially in female children, those who are premature, or those who have low birth weight. These data support caring for these complex patients at hospitals equipped to care for this fragile population.
Identifiants
pubmed: 31402130
pii: S0039-6060(19)30418-0
doi: 10.1016/j.surg.2019.06.028
pmc: PMC10353765
mid: NIHMS1665065
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
854-860Subventions
Organisme : NCI NIH HHS
ID : T32 CA211034
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.
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