Characterizing discordant discharge in late preterm and term twin pairs: a retrospective cohort study

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OBJECTIVES: Twin pairs are at risk for discordant hospital discharge, which may lead to postnatal co-twin separation. This study evaluated the prevalence of discordant discharge in late preterm and term twin pairs and identified clinical characteristics associated with this outcome. METHODS: We conducted a retrospective cohort study of live, nonanomalous, inborn twin pairs ≥ 34 weeks at two urban delivery hospitals in the United States from 2016 to 2024. The primary outcome was discordant discharge between co-twins (inter-twin discharge date ≥ 1 day). Secondary outcomes included discordant neonatal intensive care unit admission and common neonatal morbidities. Clinical characteristics were compared between twin pairs with discordant versus concordant discharge. Cochran-Armitage test was used to assess for a linear trend in the primary outcome across gestational age. Multivariable logistic regression was used to identify factors associated with discordant discharge. For the 84 twin pairs with discordant discharge, the inter-twin discharge interval ranged from 1 to 46 days with a median (IQR) of 5.0 (2.0, 9.0) days. In our adjusted model, late prematurity (aOR 14.54, 95% CI: 6.68, 31.65) and BWD ≥ 18% (aOR 2.99, 95% CI: 1.41, 6.33) were independently associated with discordant discharge. Sensitivity analyses using alternate definitions of discordant discharge (≥ 2, ≥ 3, and ≥ 5 days) and BWD (≥ 20% and ≥ 25%) demonstrated consistent results. CONCLUSION: Late prematurity and BWD ≥ 18% were independently associated with higher odds of discordant discharge. These findings may facilitate anticipatory counseling and discharge planning of this patient population.