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Rebai N, Lopriore E, Bekker V, Slaghekke F, Schoenaker MHD, Groene SG. Necrotizing enterocolitis in monochorionic twins: Insights from an identical twin model. Early Hum Dev 2024; 194:106052. [PMID: 38781714 DOI: 10.1016/j.earlhumdev.2024.106052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024]
Abstract
Necrotizing enterocolitis (NEC) is a major cause of neonatal morbidity and mortality in preterm neonates, yet its pathophysiology remains unclear. The aim of this study is to evaluate risk factors for NEC using an identical twin model. In this case-control study, all monochorionic twin pairs born in our center in 2002-2020 were retrospectively reviewed for NEC. Potential risk factors for NEC were studied. For within-pair comparison, outcomes were compared between affected and unaffected twins. Within-pair analyses showed that the twin with NEC had a lower birth weight compared to its unaffected co-twin (1100 (913-1364) vs. 1339 (1093-1755) grams). Median gestational age at birth and birth weight were lower in twin pairs in the NEC-group compared to the no-NEC group, 29.1 weeks (27.8-30.8) versus 33.6 (30.7-36.0) and 1221 g (1010-1488) versus 1865 (1356-2355) respectively. Twin pregnancies in the NEC-group were more often complicated by twin-to-twin transfusion syndrome compared to the no-NEC-group (70 % (14/20) vs. 49 % (472/962)), particularly when treated with amnioreduction. This unique population of identical twins confirms that preterm neonates with a relatively lower birth weight are more prone to develop NEC compared to their co-twin, regardless of other genetic, maternal and obstetrical factors.
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Affiliation(s)
- Nour Rebai
- Neonatoloy, Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands.
| | - Enrico Lopriore
- Neonatoloy, Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Vincent Bekker
- Neonatoloy, Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Femke Slaghekke
- Department of Obstetrics, Division of Fetal Therapy, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Michiel H D Schoenaker
- Neonatoloy, Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands; Willem-Alexander Children's Hospital, Laboratory for Pediatric Immunology, Department of Pediatrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Sophie G Groene
- Neonatoloy, Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
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Tran NN, Hutto S, Liu J, Bullock T, Virgilio R, Flowers DL. Necrotizing Enterocolitis in an Infant With a History of Twin-Twin Transfusion Syndrome: A Case Report. Cureus 2024; 16:e56720. [PMID: 38646314 PMCID: PMC11032729 DOI: 10.7759/cureus.56720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
This case report describes necrotizing enterocolitis (NEC) in an infant with a history of twin-twin transfusion syndrome (TTTS). TTTS is a volume imbalance where the anastomosis at the vascular equator between the two placentae shifts from the donor to the recipient twin. This causes a higher risk for NEC, a marked inflammation caused by bacterial infection into the intestinal wall, from prematurity and intestinal hypoperfusion. Complications include sepsis, bowel necrosis, perforation, peritonitis, and death. NEC is a leading cause of morbidity in preterm infants. A 3-month-old female with a history of TTTS and prematurity presented with her mother to the pediatric emergency department (ED) for bloody diarrhea, emesis, lack of appetite, and lethargy for 4 days. The pediatrician changed the formula due to a possible milk allergy, however, she continued to have bloody diarrhea. Over the 2 days, the patient had nonbilious and non-bloody emesis and couldn't tolerate oral intake. In the ED, labs showed neutropenia and sepsis. She had a positive fecal occult blood test (FOBT) and an abdominal x-ray that revealed dilated loops of bowel and pneumatosis intestinalis. She was started on intravenous (IV) fluids for maintenance of hydration. She was started on broad-spectrum antibiotics including intravenous (IV) vancomycin and meropenem, and had her feedings temporarily stopped. The patient was transferred to the pediatric intensive care unit (PICU) at a tertiary care/children's hospital that evening where she had a laparotomy performed to resect the diseased intestine. She was discharged 10 days after the surgery for home recovery with clinical follow-up.
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Affiliation(s)
- Nga N Tran
- Medical School, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - Sydney Hutto
- Medical School, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - James Liu
- Medical School, Kirksville College of Osteopathic Medicine, Kirksville, USA
| | | | - Richard Virgilio
- Clinical Affairs, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - David L Flowers
- Pediatric Medicine, Piedmont Columbus Regional Hospital Midtown Campus, Georgia, USA
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Rayyan M, Myatchin I, Naulaers G, Ali Said Y, Allegaert K, Miserez M. Risk factors for spontaneous localized intestinal perforation in the preterm infant. J Matern Fetal Neonatal Med 2017; 31:2617-2623. [DOI: 10.1080/14767058.2017.1350161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Maissa Rayyan
- Neonatal Intensive Care Unit, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Ivan Myatchin
- Department of Anesthesia, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Gunnar Naulaers
- Neonatal Intensive Care Unit, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Yasmin Ali Said
- Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
- Erasmus Hospital Rotterdam, Pediatric Intensive Care Unit, Rotterdam, The Netherlands
| | - Marc Miserez
- Department of Abdominal Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
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Shue EH, Soares B, Courtier J, Hogue J, Shimotake T, MacKenzie TC. Type IV intestinal atresia, congenital bilateral perisylvian syndrome, and chronic pulmonary hypertension secondary to multiple vascular disruption syndrome in a monochorionic twin. J Pediatr Surg 2012; 47:1938-42. [PMID: 23084212 DOI: 10.1016/j.jpedsurg.2012.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 08/16/2012] [Accepted: 08/17/2012] [Indexed: 10/27/2022]
Abstract
We describe a rare case of multiple intestinal atresias, congenital bilateral perisylvian polymicrogyria, and chronic pulmonary hypertension in a surviving monochorionic twin with co-twin demise. This constellation of congenital anomalies represents a multiple vascular disruption syndrome due to intrauterine vascular compromise in the setting of possible twin-to-twin transfusion syndrome.
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Affiliation(s)
- Eveline H Shue
- Department of Surgery, University of California, San Francisco, CA 94143-0570, USA
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Meconium peritonitis in both fetuses with early twin-to-twin transfusion syndrome. Twin Res Hum Genet 2012; 15:527-31. [PMID: 22853881 DOI: 10.1017/thg.2012.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Twin-to-twin transfusion syndrome (TTTS) is due to unbalanced inter-twin bloodflow through placental vascular anastomoses. We present a TTTS case treated with fetoscopic laser photocoagulation (FLP) that was complicated by perinatal meconium peritonitis in both twins. Ten weeks following laser treatment, the two fetuses showed intra-abdominal hyperechogenicity and ascites. After birth, the two newborns were surgically managed for peritonitis. We discuss the pathogenesis of this double insult. The present case highlights the role of end-circulation bowel thrombi as the potential cause of subsequent intestinal perforation.
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Lopriore E, Oepkes D, Walther FJ. Neonatal morbidity in twin-twin transfusion syndrome. Early Hum Dev 2011; 87:595-9. [PMID: 21784588 DOI: 10.1016/j.earlhumdev.2011.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 07/05/2011] [Indexed: 12/25/2022]
Abstract
Twin-twin transfusion syndrome (TTTS) is a severe complication of monochorionic twin pregnancies associated with high perinatal mortality and morbidity rates. Management in TTTS is a major challenge for obstetricians and neonatologists. Twins which are often born prematurely and may suffer from typical conditions associated with prematurity. In addition, surviving twins with TTTS are at increased risk for other complications including neurological, cardiovascular, renal and hematologic morbidity. Rare complications such as hypoxic-ischemic lesions to limbs or intestines and amniotic band syndrome have also been reported in TTTS survivors. This review focuses on the neonatal and pediatric mortality and morbidity in TTTS survivors, with special emphasis on the long-term neurodevelopmental outcome.
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Affiliation(s)
- Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands.
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Morikawa M, Sago H, Yamada T, Hayashi S, Yamada T, Cho K, Yamada H, Kitagawa M, Minakami H. Ileal atresia after fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome-a case report. Prenat Diagn 2008; 28:1072-4. [DOI: 10.1002/pd.2115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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