Premature monochorionic monoamniotic twins have lower lung compliance at birth than matched dichorionic diamniotic twins

Brian K. Jordan, Leah Bernard, Sally Segel, Mitzi D. Go, Diane Schilling, Cindy T. McEvoy

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Premature infants are born with immature lungs that demonstrate abnormal pulmonary function with differences in passive respiratory system compliance and resistance, and functional residual capacity. To our knowledge, no studies have evaluated differences in neonatal pulmonary function based on the type of twin gestation, or chorionicity. Given the effect of chorionicity on outcomes, we aimed to study the effect of twin type, monochorionic monoamniotic (MCMA) vs dichorionic diamniotic (DCDA), on neonatal early pulmonary function tests. METHODS: In this prospective cohort study, 5 sets of DCDA twins were matched to 5 sets of MCMA twins on gestational age at delivery, latency from antenatal corticosteroid exposure, birthweight, race and gender. Mean values were compared for passive respiratory system compliance and resistance, functional residual capacity, and tidal volume. RESULTS: MCMA infants had a significantly lower compliance (0.64 vs 1.25 mL/cm H2O /kg; p = 0.0001) and significantly higher resistance (0.130 vs 0.087 cm H2O /mL/sec; p = 0.0003) than DCDA infants. Functional residual capacity was lower for MCMA than DCDA infants (17.5 vs 23.4 mL/kg; p = 0.17). Further, 80% of MCMA infants required intubation for surfactant administration compared to 20% of DCDA infants, indicating the clinical significance of these objective measures. CONCLUSIONS: Due to the matched case-control design, causality cannot be established. However, we speculate that these differences in lung function may derive from differential exposure to preterm labor and endogenous maternal corticosteroid exposure. Further study is necessary to establish the true causal relationship.

Original languageEnglish (US)
Pages (from-to)87-92
Number of pages6
JournalJournal of Neonatal-Perinatal Medicine
Issue number1
StatePublished - 2023


  • Chorionicity
  • function residual capacity
  • neonate
  • pulmonary function
  • respiratory system compliance
  • respiratory system resistance
  • twins

ASJC Scopus subject areas

  • General Medicine


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