LOW WEIGHT LENGTH RATIO TO ASSESS RISK OF CEREBRAL-PALSY AND PERINATAL-MORTALITY IN TWINS/

The etiology of increased rates of cerebral palsy (CP) in twins is unc lear, but likely is associated with growth retardation, which occurs m ore often in twins. Asymmetric growth restriction, a form of growth re tardation, has been found associated with increased rates of perinatal morbidity in infants with normal centile birthweights, and occurs mor e often in twins. Data from 55,457 infants were evaluated. Association s between twinning, CP, and neonatal mortality were evaluated. Influen ces of confounding factors, such as prematurity, perinatal depression, and asymmetric growth were assessed. Although twinning was a signific ant univariate correlate of both CP and neonatal mortality, low weight /length ratio (a marker of asymmetric growth) was a better correlate o f both outcomes, and twinning was not significantly associated with ei ther outcome after logistic adjustment for factors such as prematurity , perinatal depression, and low weight/length ratio. Low weight/length ratio occurred more often in twins of advancing gestational age, supp orting a hypothesis of competition for nutritional resources as the ca use for increased rates of low weight/length ratio in twins as compare d with singletons. Asymmetric growth restriction is an important corre late of neonatal morbidity in twins, and should be considered when the se factors are assessed in infants from multiple gestations.