Premature twins survival rate

Today most children born very preterm – from 28 weeks – survive in high-income countries. In low-income countries about half of babies born at or below 32 weeks die. WHO estimates that preterm birth was responsible for nearly 1 million deaths in 2015. Three-quarters of them could be saved with current, cost-effective intervention.

How will my premature twins do?

How your babies will do depend on the course of your pregnancy and on how early your babies are born. It also depends on the individual babies and the care that they receive. Being born prematurely means that there are some long term risks. There is a greater risk of being diagnosed with cerebral palsy, mental retardation, visual and hearing impairments and more subtle disorders of different central nervous system functions, such as language disorders, learning disabilities, attention deficit-hyperactivity disorders and behavioral problems. Consult your doctor or your Maternal-Fetal Medicine (MFM) specialist if you’re worried about giving birth to premature twins. 

Premature twins week by week overview

Twins born at 27 weeks
Twins born at 27 weeks are in the extremely preterm category. More than 90 percent of extremely preterm babies born in low-income countries die within the first few days of life. Less than 10 percent of extremely preterm babies die in high-income settings.

Twins born at 28 weeks
The vast majority of twins born at 28 weeks survive in high-income countries. But they are in for quite a long stay at the Neonatal Intensive Care Unit (NICU).

Twins born at 29 weeks
Twins born at 29 weeks require treatment with oxygen, surfactant and mechanical assistance to help them breathe. They’ll need help eating.

Twins born at 30 weeks
In low-income countries about half of babies born at or below 32 weeks die. Twins born at 30 weeks need to be born in a medical facility equipped to deal with preterm babies. Proper medical care is essential. Your babies will need help breathing as well as eating. The NICU staff will guide you on how to start breast- or bottle feeding once your babies have developed their sucking reflexes.

Twins born at 31 weeks
Twins born at 31 weeks will need help breathing and eating. It’s important that they gain weight and grow.

Twins born at 32 weeks
Twins born at 32 weeks are considered moderate to late preterm, which means that they’ve hit a major milestone. They’re no longer considered born very preterm.

Twins born at 33 weeks
Your babies have come far, but they still need to grow and gain more weight. The far majority of babies born at 33 weeks will need help breathing.

Twins born at 34 weeks
Twins born at 34 weeks will probably need help to learn to regulate temperature and master eating, and some will have breathing issues.

Twins born at 35 weeks
Twins born at 35 weeks may not need any medical treatment. They may be able to go straight to the maternity ward with you. In most cases they are now able to breathe by themselves.

Twins born at 36 weeks
Most babies have mature lungs by now. This means that your babies won’t need special help breathing, if they’re born at 36 weeks. However, since babies develop at different rates, there are exceptions to this.

Twins born at 37 weeks
Even though your twins are in the moderate to late preterm category, it’s very likely that they won’t need medical treatment. They may very well be able to go straight to the maternity ward with you.

Premature twins & attachment

Studies have shown that parents are more likely to have a less secure attachment to babies born preterm compared to babies born at term. A twin study concluded that parents with premature twins face similar attachment issues. The study showed that both mom and dad have a less secure attachment to babies born prematurely.  The study also showed that for fathers with preterm children less education and having babies with lower developmental scores were associated with lower attachment scores. Fathers seem to find the interaction with less developed children more difficult than with more developed children.

Premature twins, dad & the NICU

A PhD thesis from Denmark focused on how to be better at understanding and acknowledging the fathers of premature babies at the Neonatal Intensive Care Unit (NICU). Eight principles were developed. The principles focused on early involvement of dads by making sure that the dads were able to take part in the care of their premature babies as soon as they were born.

1. Early skin contact between father and child immediately after birth while the mom is being treated.

2. Planning of important events so fathers can take part. That could for instance be the transfer from the incubator or the first bath.

3. Fathers should be able to get information directly from the healthcare professionals.

4. Better planning so fathers can participate in conversations about the child’s development.

5. Financial advice and information about opportunities for leave.

6. Formation of birth groups for fathers.

7. The possibility that a family member or friend could help the parents in the Neonatal Intensive Care Unit (NICU).

8. Making it possible for older siblings to stay at the department.

They’re no longer considered born very preterm. This is according to the World Health Organization (WHO), who subcategories preterm birth based on gestational age.

extremely preterm (<28 weeks)
very preterm (28 to <32 weeks)
moderate to late preterm (32 to <37 weeks)

What happens to twins born at 35 weeks?

Twins born at 35 weeks may not need any medical treatment. They may be able to go straight to the maternity ward with you. In most cases, they’re now able to breathe by themselves.

The main thing they need to do at this point is to grow and gain weight. They may need help with feeding, but not necessarily. The staff at the hospital should guide you and help you with breastfeeding when the time is right.

If you’re not able to breastfeed right away, it’s important that you start pumping. For the first few days, before your milk comes in, hand expression is often the most effective way to express colostrum.

Colostrum is the first milk your breasts produce during pregnancy.  It’s much thicker than the milk that is produced when your milk comes in. It’s a yellowish or clear fluid and full of antibodies and immunoglobulins.

When your milk supply increases, it changes from colostrum to breast milk.

How big will my twins be?

Your babies measure approximately 46 centimeters (18.11 inches), when you’re 35 weeks pregnant with twins. The median weight for dichorionic twins in this week is 2486 grams (5lbs, 7oz).

For monochorionic twins, it’s 2386 grams (5lbs, 4oz). Have a look at our estimated fetal weight charts to learn more about how dichorionic and monochorionic twins grow in the second half of pregnancy.

Can I do something to help my babies?

Frequent skin-to-skin contact is good for both you and your babies. It comforts your babies and helps them adjust to the “new” world they’ve been born into.

Skin-to-skin contact is – among other things – also associated with a decreased likelihood of infection.

These identical twin boys were born at 34+1 weeks in 2017. They shared a placenta but had an unequal share, so one was 3lbs (1360 grams) at birth and the other 4lb, 3oz (1899 grams). They both went into Special Care straight after they were born.

The bigger twin just to help him regulate his temperature. He was back with his mom within a few hours after birth. The smaller twin was there just to gain weight, he had to be 4lbs (1814 grams) before he could come home.

The doctors were pleased with how healthy they both were. The smaller twin came home from special care after two and a half weeks. 

These fraternal boy-boy twins were born at 34+2 weeks. They were born via planned c-section due to growth issues with twin a. They weighed 3lb, 14oz (1757 grams) & 4lb, 6oz (1984 grams) at birth. 

They stayed in the NICU for 2 weeks to wean into bottles and grow. Twin 2 had slight jaundice, he was under a light for 2 days. Other than that, there were no complications, and the boys have no long term health issues from being born premature.

These mo-di twin boys were born at 34+0 weeks. One twin weighed 4lb, 12oz (2154 grams), the other twin weighed 3lbs, 6oz (1530 grams). Baby a was 5 days in the NICU,  and baby b was 14 days in the NICU.

They didn’t have any major issues, they just needed to grow and gain weight which they did really fast. Their mother had betamethasone shots before delivery, maturing the lungs of the babies. They didn’t have any breathing issues.

extremely preterm (<28 weeks)
very preterm (28 to <32 weeks)
moderate to late preterm (32 to <37 weeks)

Will my babies survive?

The majority of twins born at 29 weeks survive in high-income countries. Proper medical care is essential. The median weight for dichorionic twins at 29 weeks is 1367 grams (3lbs). For monochorionic twins the median weight is 1293 grams (2lbs, 13oz). Look at estimated fetal weight charts to learn more about how twins grow in the second half of pregnancy. Please be aware that monochorionic twins are consistently smaller than dichorionic twins.

What happens to me if I go into preterm labour?

If you go into preterm labour steroid injections should be given before birth, maturing the lungs of your babies. The WHO also recommends that the mother is given antibiotics when her water breaks before the onset of labour, and magnesium sulfate to prevent future neurological impairment of the children. You need to give birth at a medical facility equipped to deal with very preterm babies.

How will my babies be doing?

If your twins are born at 29 weeks, they’ll need to spend a few weeks or months in the Neonatal Intensive Care Unit (NICU). Twins born at 29 weeks require treatment with oxygen, surfactant, and mechanical assistance to help them breathe. They’ll need help eating. Some will be able to fed through a tube and others will be fed intravenously. The NICU staff will guide you regarding how and when to start breastfeeding, pumping and / or bottle feeding.

Read stories about different mothers who’ve given birth prematurely and at term.

extremely preterm (<28 weeks)
very preterm (28 to <32 weeks)
moderate to late preterm (32 to <37 weeks)

What happens to twins born at 37 weeks?

Even though your twins are in the moderate to late preterm category, it’s very likely that they won’t need medical treatment. They may be able to go straight to the maternity ward with you. They won’t have severe issues related to being born prematurely. The main thing they need to do at this point is to grow and gain weight. The median weight for dichorionic twins born at 37 weeks is 2869 grams (6lbs, 5oz). For monochorionic twins it’s 2697 grams (5lbs, 15oz). Have a look at our estimated fetal weight charts to learn more about how dichorionic and monochorionic twins grow in the second half of pregnancy.

Will I be able to breastfeed?

Chances are good that you’re able to nurse straight away. Among other things it depends on how developed your babies sucking reflexes are. Ask for guidance from the hospital staff, if you’d like help in relation to breast- or bottle-feeding twins.

extremely preterm (<28 weeks)
very preterm (28 to <32 weeks)
moderate to late preterm (32 to <37 weeks)

How will my babies be doing?

Most babies have mature lungs by now. This means that your babies won’t need special help breathing, if they’re born at 36 weeks. However, since babies develop at different rates, there are exceptions to this. Many twins born at 36 weeks will be able to leave the hospital with their parents without having to stay in the Neonatal Intensive Care Unit (NICU). It depends on how they’re doing physically and whether they’re big enough. They also need to be able to eat on their own – either breastfeeding or bottle feeding.  Look at estimated fetal weight charts to learn more about how dichorionic and monochorionic twins grow in the second half of pregnancy. Dichorionic twins have their own placentas.  Monochorionic twins share a placenta.

When will I be able to breastfeed my babies?

You might be able to breastfeed straightaway. The staff at the hospital should be able to guide you. If you don’t breastfeed in the beginning, it’s important that you start pumping. For the first few days, before your milk comes in, hand expression is often the most effective way to express colostrum. Colostrum is the first milk your breasts produce during pregnancy.  If it’s difficult to breastfeed or pump, you might benefit from speaking with a lactation consultant. Ask if there’s a consultant employed at the hospital.

These di-di twin boys were born at 35+0 weeks in 2007. They were 5.5lb (2494 grams) & 5.3lb (2404 grams) at birth. They spent 2 weeks in the NICU – they needed help with temperature and feeding tubes. They have no long term issues due to being premature. 

These fraternal boy/girl twins were born at 35+4 weeks. The twin boy was 5lb, 10oz (2551 grams) at birth, and the twin girl was 4lb, 13oz (2182 grams). The girl didn’t go to the NICU, but the boy had to for 15 days. He was born with fluid in his lungs and also needed to maintain a certain temperature before he was able to be released. 

Fathers are a resource

Based on conversations with parents and staff, Betty Nørgaard has developed eight principles for involvement of the fathers in Kolding Hospital’s neonatal department over the past six years. Among other things, it is now recommended that father and child has skin-to-skin contact as soon as possible to develop a relationship early on while the mother is being treated.

Fathers have different concerns

Premature children are often admitted to the term date where they should have been born. Therefore, some families are in the department for up to three months.
“In the past, dad might only have been there for the first 14 days if that at all was possible due to work and older children. This meant that he was lacking knowledge about his child’s situation because information was almost always conveyed through the mother,” says Betty Nørgaard.
Therefore, Kolding Hospital is planning to schedule important conversations and events such as transfer from the incubator or the first bath, so that the fathers can participate.
“Fathers have questions and concerns different from the mother. Mothers are interested in hearing about the relationship with the child and they accept that the samples “look fine.” Fathers need more concrete knowledge so that they can get an overview of the further process. This makes them better able to support their wives.”

Share frustrations with other dads

Another successful initiative is that the fathers are brought together in small groups. Here they share their concerns and frustrations with others in the same situation.
“We have experienced fathers who did not share their concerns with anyone through very long hospitalization. They did not feel they could talk to their wife because they didn’t want to burden her further,” says Betty Nørgaard.
Similarly, some people find it difficult to handle the monotony when the child has stabilized and slowly grows stronger.
“The fathers can lose their patience due to the same routine day in and day out. In the fathers’ groups we’ve seen that the men really have opened up to each other. It creates a very special bond, and afterwards they know and support each other as they meet in the hallways.”

8 Principles for a father-friendly neonatal department

• Early skin contact between father and child immediately after birth while mother is being treated.
• Planning of important events, so fathers can take part in the transfer from the incubator or the first bath.
• Fathers should be able to obtain information directly from the healthcare professionals.
• Planning so fathers can participate in conversations about the child’s development.
• Advice on economics and opportunity for leave.
• Formation of birth groups.
• The possibility that a family member or friend may sometimes help the parents in the department.
• Possibility that older siblings can stay at the department.

extremely preterm (<28 weeks)
very preterm (28 to <32 weeks)
moderate to late preterm (32 to <37 weeks)

Will my babies survive?

Twins born at 28 weeks are born very preterm. The majority of twins born at 28 weeks survive in high-income countries. In low-income countries about half of babies born at or below 32 weeks die. For extremely preterm babies born in low-income countries more than 90 percent die within the first few days. In high-income settings less than 10 percent of babies of this gestation die. Babies born at 28 weeks desperately need proper treatment and monitoring in order to have the best possible outlook. Proper medical care is essential.

What happens to me if I go into preterm labour?

If you go into preterm labour steroid injections should be given before birth, maturing the lungs of your babies. The WHO also recommends that the mother is given antibiotics when her water breaks before the onset of labour and magnesium sulfate to prevent future neurological impairment of the children. You need to give birth at a medical facility equipped to deal with very preterm babies.

What happens to twins born at 28 weeks?

If your twins are born at 28 weeks, they’ll need to spend a few weeks or months in the Neonatal Intensive Care Unit (NICU). Twins born at 28 weeks require treatment with oxygen, surfactant, and mechanical assistance to help them breathe. They’ll need help eating. Some will be able to fed through a tube and others will be fed intravenously. The NICU staff will guide you on how to start breast- or bottle feeding once your babies have developed their sucking reflexes.

Can I do something to help my babies?

Studies show that babies subjected to kangaroo care – frequent skin-to-skin contact – are more likely to maintain a healthy body temperature, and show increased cardio-respiratory stability. Kangaroo care has also been associated with decreased likelihood of infection, severe illness, and death. Be aware though that it most likely will take a while before you are able to hold your babies – they need to be in stable conditions first. You’ll probably be allowed to touch them before you are allowed to hold them, and touching is also beneficial.