Neonatal Hemodynamic Characteristics of the Recipient Twin of Twin-To-Twin Transfusion Syndrome Not Treated with Fetoscopic Laser Surgery
Abstract
:1. Introduction
2. Materials and Methods
2.1. Population
2.2. Data Collection
2.3. Management Protocol
2.4. Statistics
3. Results
3.1. Study Population and Clinical Characteristics
3.2. Characterization of the Hemodynamic Disorders in the Recipient Twins
3.3. Factors Associated with Cardiac Failure (Table 3)
NoHI + HighBP | CF | OR | 95% CI | p | |||
---|---|---|---|---|---|---|---|
n = 27 | n = 15 | ||||||
Pregnancy | |||||||
Threatened preterm labor, n (%) | 6 | (22) | 2 | (13) | 0.6 | (0.1–3.4) | 1.00 |
Prenatal death of the donor twin | |||||||
Gestational diabetes, n (%) | 1 | (4) | 1 | (7) | 1.9 | (0.1–32.1) | 1.00 |
Pre-eclampsia, n (%) | 1 | (4) | 0 | (0) | * | 1.00 | |
Premature rupture of membranes, n (%) | 4 | (15) | 0 | (0) | * | 0.28 | |
Antenatal corticosteroid therapy, n (%) | 19 | (70) | 10 | (67) | 0.8 | (0.2–3.3) | 1.00 |
TTTs | |||||||
Amnioreduction, n (%) | 14 | (52) | 8 | (53) | 1.1 | (0.3–3.8) | 1.00 |
Gestational age, median (Q1–Q3) | 28 | (26–29) | 28 | (28–29) | 0.65 | ||
Associated-TAPS, n (%) | 0 | (0) | 4 | (27) | * | 0.012 | |
Quintero stage | |||||||
Quintero stage 1 or 2, n (%) | 16 | (59) | 6 | (40) | 0.5 | (0.1–1.7) | 0.34 |
Quintero stage 3 or 4, n (%) | 8 | (30) | 9 | (60) | 3.6 | (0.9–13.4) | 0.52 |
Quintero stage 5, n (%) | 3 | (11) | 0 | (0) | * | 0.54 | |
Selective interruption during pregnancy, n (%) | 6 | (22) | 0 | (0) | * | 0.07 | |
Birth | |||||||
Mode of delivery | |||||||
Elective cesarean section, n (%) | 20 | (74) | 5 | (33) | 0.2 | (0.1–0.7) | 0.020 |
Emergency cesarean section, n (%) | 7 | (26) | 10 | (67) | 5.7 | (1.4–22.6) | |
Term | |||||||
Very preterm, n (%) | 14 | (52) | 13 | (87) | 6.0 | (1.1–32.1) | 0.040 |
Moderate or late preterm, n(%) | 13 | (48) | 2 | (13) | 0.2 | (0–0.9) | |
Male, n (%) | 12 | (44) | 7 | (47) | 1.1 | (0.3–3.9) | 1.00 |
Weight discordance with the twin > 25%, n (%) | 7 | (26) | 3 | (20) | 0.7 | (0.2–3.3) | 1.00 |
APGAR score | |||||||
Low 1-min APGAR score, n (%) | 9 | (33) | 12 | (80) | 8.0 | (1.8–35.8) | 0.009 |
Low 5-min APGAR score, n (%) | 3 | (11) | 7 | (47) | 7.0 | (1.5–33.7) | 0.020 |
Umbilical cord acidosis, n (%) | 0 | (0) | 3 | (20) | * | 0.040 | |
Hemoglobin at birth > 20 g/dL, n (%) | 2 | (7) | 8 | (53) | 14.3 | (2.5–83.2) | 0.002 |
Hematocrit at birth > 65%, n (%) | 1 | (4) | 4 | (27) | 9.5 | (1.0–94.4) | 0.047 |
3.4. Mortality Rate
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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NoHI | HighBP | CF | ||||
---|---|---|---|---|---|---|
n = 15 | n = 12 | n = 15 | ||||
Pregnancy | ||||||
Threatened preterm labor, n (%) | 3 | (20) | 3 | (25) | 2 | (13) |
Prenatal death of the donor twin, n (%) | 8 | (53) | 1 | (8) | 0 | (0) |
Gestational diabetes, n (%) | 0 | (0) | 1 | (8) | 1 | (7) |
Pre-eclampsia, n (%) | 0 | (0) | 1 | (8) | 0 | (0) |
Premature rupture of membranes, n (%) | 2 | (13) | 2 | (17) | 0 | (0) |
Antenatal corticosteroid therapy, n (%) | 9 | (60) | 10 | (83) | 10 | (67) |
Birth | ||||||
Gestational age, median (Q1–Q3) | 33 | (32–34) | 29 | (28–30) | 29 | (28–31) |
Male, n (%) | 5 | (33) | 7 | (58) | 7 | (47) |
Weight (g), median (Q1–Q3) | 1800 | (1665–2082) | 1293 | (1168–1533) | 1265 | (1150–1607) |
Weight (percentile), median (Q1–Q3) | 53 | (31–77) | 71 | (55–79) | 66 | (34–75) |
% difference of weight with the twin, median (Q1–Q3) | 20.1 | (8.7–28) | 22.8 | (11.8–30.1) | 18.2 | (12.9–22.8) |
APGAR score | ||||||
1 min, median (Q1–Q3) | 8 | (8–9) | 6 | (4–8) | 5 | (2–6) |
5 min, median (Q1–Q3) | 10 | (9–10) | 9 | (8–9) | 8 | (4–9) |
Umbilical cord pH, median (Q1–Q3) | 7.36 | (7.31–7.39) | 7.37 | (7.36–7.39) | 7.30 | (7.26–7.37) |
Hemodynamic morbidity | ||||||
High systolic blood pressure, n (%) | 0 | (0) | 12 | (100) | 15 | (100) |
Ventricular hypertrophy, n (%) | 2/11 | (33) | 12 | (100) | 15 | (100) |
Patent ductus arteriosus requiring treatment, n (%) | 0 | (0) | 0 | (0) | 1 | (7) |
Other neonatal morbidities | ||||||
Hemodilution, n (%) | 0 | (0) | 1 | (8) | 4/15 | (27) |
Bronchopulmonary dysplasia, n (%) * | 0 | (0) | 2 | (17) | 1/9 | (11) |
Severe intraventricular hemorrhage (>2), n (%) | 0 | (0) | 1 | (8) | 3/15 | (20) |
Periventricular leukomalacia, n (%) * | 0 | (0) | 1 | (8) | 4/9 | (44) |
Secondary sepsis, n (%) * | 2 | (13) | 2 | (17) | 4/9 | (44) |
Necrotizing enterocolitis, n (%) * | 1 | (7) | 1 | (8) | 0/9 | (0) |
Acute kidney injury, n (%) | 0 | (0) | 3 | (25) | 14/15 | (93) |
Death | ||||||
Death in the first five days of life, n (%) | 0 | (0) | 0 | (0) | 6 | (40) |
Age at death (hours), median (Q1–Q3) | 47 | (26–65) |
HighBP | CF | p | |||
---|---|---|---|---|---|
n = 12 | n = 15 | ||||
Birth | |||||
Gestational age, median (Q1–Q3) | 29 | (28–30) | 29 | (28–31) | 0.77 |
Weight (g), median (Q1–Q3) | 1293 | (1168–1533) | 1265 | (1150–1607) | 0.98 |
Weight (percentile), median (Q1–Q3) | 71 | (55–79) | 66 | (34–75) | 0.26 |
% difference of weight with the twin, median (Q1–Q3) | 22.8 | (11.8–30.1) | 18.2 | (12.9–22.8) | 0.51 |
APGAR score | |||||
1 min, median (Q1–Q3) | 6 | (4–8) | 5 | (2–6) | 0.35 |
5 min, median (Q1–Q3) | 9 | (8,9) | 8 | (4–9) | 0.15 |
Umbilical cord pH, median (Q1–Q3) | 7.37 | (7.36–7.39) | 7.30 | (7.26–7.37) | 0.05 |
Hemodynamic characteristics | |||||
High systolic blood pressure, n (%) | 12 | (100) | 15 | (100) | 1.00 |
Ventricular hypertrophy, n (%) | 12 | (100) | 15 | (100) | 1.00 |
Maximum IVSd (mm), median (Q1–Q3) | 4.2 | (3.8–5.1) | 5.0 | (4.2–5.3) | 0.32 |
Hydrocortisone hemisuccinate, n (%) | 2 | (17) | 6 | (40) | 0.41 |
Renal-dose dopamine, n (%) | 0 | (0) | 4 | (27) | 0.10 |
Fluid expension with saline solution, n (%) | 1 | (8) | 8 | (53) | 0.019 |
Antihypertensive treatment | |||||
Nicardipine, n (%) | 12 | (100) | 15 | (100) | 1.00 |
Starting time (hours of life), median (Q1–Q3) | 4 | (4–23) | 3 | (2–16) | 0.18 |
Maximal dose (μg/kg/min), median (Q1–Q3) | 0.6 | (0.5–1.2) | 1.0 | (0.7–1.8) | 0.08 |
Inotropic treatment (Milrinone, Dobutamine), n (%) | 0 | (0) | 14 | (93) | |
Milrinone, n (%) | 5 | (33) | |||
Starting time (hours of life), median (Q1–Q3) | 22 | (16–39) | |||
Maximal dose (μg/kg/min), median (Q1–Q3) | 0.2 | (0.2–0.2) | |||
Dobutamine, n (%) | 13 | (87) | |||
Starting time (hours of life), median (Q1–Q3) | 13 | (6–26) | |||
Maximal dose (μg/kg/min), median (Q1–Q3) | 20.0 | (15.0–20.0) | |||
Biological parameters | |||||
pH in the first 2 days of life, median (Q1–Q3) | 7.33 | (7.29–7.37) | 7.26 | (7.23–7.29) | <0.001 |
Lactate in the first 2 days of life, median (Q1–Q3) | 1.6 | (1.2–2.2) | 2.1 | (1.5–3.3) | 0.07 |
Acute kidney injury, n (%) | 3 | (25) | 14 | (93) | <0.001 |
Stage 1 of KDIGO classification, n (%) | 2 | (17) | 1 | (7) | 0.57 |
Stage 2 of KDIGO classification, n (%) | 1 | (8) | 0 | (0) | 0.44 |
Stage 3 of KDIGO classification, n (%) | 0 | (0) | 13 | (87) | <0.001 |
Maximum serum blood urea nitrogen (mmol/L), median (Q1–Q3) | 6.7 | (6.1–8.0) | 13.3 | (8.8–17.9) | 0.003 |
Maximum serum creatinine (µmol/L), median (Q1–Q3) | 77.0 | (62.3–87.5) | 134.0 | (90.8–157.8) | 0.005 |
Urinary examinations, n (%) | 9 | (75) | 5 | (33) | |
Urinary sodium excretion (mmol/L), median (Q1–Q3) | 38.0 | (33.0–54.0) | 28.5 | (13.0–36.0) | 0.011 |
Proteinuria (g/L), median (Q1–Q3) | 0.15 | (0.08–0.24) | 0.30 | (0.18–0.49) | 0.032 |
Urinary to serum ratio of urea nitrogen, median (Q1–Q3) | 8.34 | (7.08–8.70) | 5.74 | (3.28–6.51) | 0.017 |
Urinary to serum ratio of creatinine, median (Q1–Q3) | 10.74 | (9.24–13.17) | 11.92 | (6.30–19.34) | 0.44 |
Urinary sodium to potassium excretion ratio, median (Q1–Q3) | 5.17 | (3.26–8.65) | 1.44 | (0.99–1.62) | <0.001 |
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Chambon, E.; Hachem, T.; Salvador, E.; Rigourd, V.; Bellanger, C.; Stirnemann, J.; Kermorvant-Duchemin, E.; Tissieres, P.; Ville, Y.; Lapillonne, A. Neonatal Hemodynamic Characteristics of the Recipient Twin of Twin-To-Twin Transfusion Syndrome Not Treated with Fetoscopic Laser Surgery. Children 2022, 9, 1766. https://doi.org/10.3390/children9111766
Chambon E, Hachem T, Salvador E, Rigourd V, Bellanger C, Stirnemann J, Kermorvant-Duchemin E, Tissieres P, Ville Y, Lapillonne A. Neonatal Hemodynamic Characteristics of the Recipient Twin of Twin-To-Twin Transfusion Syndrome Not Treated with Fetoscopic Laser Surgery. Children. 2022; 9(11):1766. https://doi.org/10.3390/children9111766
Chicago/Turabian StyleChambon, Edouard, Taymme Hachem, Elodie Salvador, Virginie Rigourd, Claire Bellanger, Julien Stirnemann, Elsa Kermorvant-Duchemin, Pierre Tissieres, Yves Ville, and Alexandre Lapillonne. 2022. "Neonatal Hemodynamic Characteristics of the Recipient Twin of Twin-To-Twin Transfusion Syndrome Not Treated with Fetoscopic Laser Surgery" Children 9, no. 11: 1766. https://doi.org/10.3390/children9111766