Funisitis as a Risk Factor for Adverse Neonatal Outcomes in Twin Neonates with Spontaneous Preterm Birth: A Retrospective Cohort Study

Purpose: Funisitis, inflammation of the umbilical cord, is considered a strong risk factor for adverse neonatal outcomes; however, a clinical definition of funisitis has not been established. In this study, we aimed to determine the clinical significance of funisitis in twin neonates with spontaneous preterm birth. Materials and Methods: The study included preterm twin neonates (<35 weeks) delivered after spontaneous preterm labor and/ or preterm premature rupture of amniotic membranes. The presence of funisitis was examined in the umbilical cord of each twin. We analyzed the risk of adverse neonatal outcomes according to the presence and absence of funisitis. Adverse neonatal out-comes were defined as the occurrence of neonatal mortality, significant morbidity, or both. Results: Among 474 preterm neonates (237 twin pairs) included in this study, the frequency of funisitis was 6.5% (31 cases). Fu-nisitis was significantly associated with neonatal mortality and adverse neonatal outcomes after adjustment for confounding variables [neonatal mortality, odds ratio (OR) 9.043, 95% confidence interval (CI) 2.620-31.204; adverse neonatal outcome, OR 2.445, 95% CI 1.017-5.875]. The concordance rate of funisitis between the twins was 10.7%, and in the absence of funisitis in one twin, the risk of neonatal mortality or adverse neonatal outcome was not influenced by the presence of funisitis in the other twin. Conclusion: The presence of funisitis appears to be associated with an increased risk for adverse neonatal outcomes in twin neo-nates with spontaneous preterm birth.