Objective: Multiple pregnancies are associated with an increased risk of adverse maternal and neonatal outcomes, especially those associated with prematurity. The purpose of this study was to assess the mortality and short-term morbidity of infants born from multiple pregnancies and hospitalized in neonatal intensive care units.

Methods: The medical records of women who gave birth to multiple neonates over four-year period and their children were retrospectively analyzed. The study examined neonatal outcomes, specifically mortality, and short-term morbidity, during hospitalization.

Results: The study included 220 neonates from 126 multiple pregnancies (three triplets and 123 twins). The preterm birth rate was 97%. Presentation anomalies, cesarean section rates, assisted reproductive techniques (ART), congenital anomalies, and antenatal corticosteroid administration were statistically higher in multiple births compared to singleton births. In multiple pregnancies, the rates of spontaneous, in-vitro fertilization, and intrauterine insemination were 73%, 21.5%, and 5.5%, respectively. There were 78.5% dichorionic diamniotic pregnancies, 14.5% monochorionic diamniotic pregnancies, 4.7% monochorionic monoamniotic pregnancies, and 2.3% trichorionic triamniotic pregnancies detected. Monochorionic pregnancies were associated with lower birth weight and longer duration of total parenteral nutrition (1808±548 vs. 1994±524g, p=0.02, and 12.6±9.9 vs. 8.3±7.1days, p=0.005, respectively). Significantly higher rates of monochorionic placentation, higher maternal age, and maternal disease frequency were observed in ART multiple pregnancies (p=0.001, p=0.01 and p=0.02, respectively. Birth order had no significant effect on perinatal outcomes. Male infants were discharged more frequently with the diagnosis of small for gestational age (32.5% vs. 14.5%, p=0.003). Fourteen infants were lost, including four in utero, six due to extreme prematurity, one due to Trisomy 18, three due to sepsis and necrotizing enterocolitis in the neonatal period.

Conclusion: Multiple pregnancy and associated complications, especially prematurity and low birth weight, are increasing. Both antenatal and postnatal approaches need to be improved and specialized to improve neonatal outcomes.

Keywords: In vitro fertilization, morbidity, mortality, multiple pregnancy, neonate, twins