Multiple birth versus neonatal brain lesions in children born prematurely as predictors of perceptuo-motor impairment at age 6.

ABSTRACT

Our primary objective in this study was to test the multiple birth hypothesis, which asserts that multiple gestation and delivery, per se, entail a greater likelihood of adverse outcome than for singletons. Our second objective was to assess the power of various neonatal risk indicators to predict developmental status at school age. In particular, we sought to weigh multiple birth as an indicator of outcome against brain lesions visualized by ultrasonography. Additional neonatal indicators included birth weight, gestational age, weight relative to gestational age, and gender. At 6 years of age, children were assessed on selected aspects of perceptuo-motor competence and verbal ability. Previous findings favoring the multiple birth hypothesis have been mostly confined to comparisons of unmatched groups of twins and singletons. This study limited investigation to children born prematurely (before 35 weeks gestation) and included comparison of multiplet-singleton pairs, matched on type and extent of any lesions, gestational age, and birth weight. The full sample comprised 124 singletons and 45 multiplets (twins, triplets, and quadruplets). About half exhibited brain lesions in the neonatal period. In this population, there was no tendency for singletons to do better than multiplets, either in the unmatched or matched samples, at 6 years of age. Lesions, supplemented by gestational age, were highly predictive of outcome on the selected measures. In contrast, the multiple birth factor was of no predictive utility.