Twins and triplets with necrotizing enterocolitis
T. E. Wiswell and C. T. Hankins
Walter Reed Army Institute of Research, Washington, DC.
We reviewed 2856 multiple-gestation pregnancies from 1980 to 1985 to
identify whether birth order or other features (eg, asphyxia) were
significant risk factors for the development of necrotizing enterocolitis
(NEC). There were 42 infants identified as having NEC from 30 pairs of
twins and three sets of triplets. The firstborn was diagnosed with NEC in
19 (45%) of the cases, with the disorder occurring in the secondborn in 23
cases (55%). While infants A and B were simultaneously affected in nine
cases, among the three sets of triplets, no thirdborn infants developed
NEC. Although the secondborn infants had significantly lower one-minute
Apgar scores and a more frequent need for resuscitation, they were no more
prone to develop NEC than were firstborn infants. Multiple gestation, birth
order, feeding practices, and a number of other features we evaluated were
not associated with the development of NEC. Our findings support the
contention that prematurity is the only consistent risk factor in the
development of NEC.
