The role of the NEOMOD scale in assessment of the severity of multiple organ failure and prediction of outcomes in premature monochorionic twins in the period of early neonatal adaptation

Early neonatal adaptation is a critical stage of the transition to extrauterine life, requiring early verification of markers of severe conditions to reduce the risk of adverse outcomes.

The aim of the study. To assess the incidence and prognostic significance of multiple organ failure (≥2 points) using the NEOMOD scale in premature monochorionic diamniotic twins depending on the course of the antenatal period, and to describe the structure of multiple organ dysfunction in the first hours of life.

Materials and methods. We retrospectively analyzed clinical and laboratory signs of multiple organ dysfunction in premature monochorionic twins aged 220–366 weeks. Based on the presence/absence of antenatal complications, the following groups were identified: twin-to-twin transfusion syndrome (n=223); selective fetal growth restriction syndrome (n=168); and uncomplicated antenatal period (n=357). The groups were comparable for the main parameters.

Results. Multiple organ failure, assessed using the modified NEOMOD (Neonatal Multiple Organ Dysfunction) scale, was more frequently recorded in cases of antenatal complications (79,3%) compared to uncomplicated pregnancies (49,9%; p<0,001). Severe multiple organ failure (≥5 points) was more common in twins who had twin-to-twin transfusion syndrome (p<0,001). The highest NEOMOD values (9 points) were observed in infants who died within the first day of life.

Conclusion. The risk and severity of multiple organ failure in monochorionic twins are associated with extremely low birth weight, perinatal infection, and specific antenatal complications. The leading contribution to the severity of the condition is made by respiratory, microcirculatory and hemodynamic disorders, which determine the level of NEOMOD and the length of stay in the neonatal intensive care unit.

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