Kuehne Benjamin, Trieschmann Jan, Butzer Sarina Kim, Mehler Katrin, Gottschalk Ingo, Kribs Angela, Oberthuer André
Division of Neonatology, Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany.
Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany.
Children (Basel). 2024 Oct 17;11(10):1256. doi: 10.3390/children11101256.
Monochorionic (MC) twins are at risk for severe twin-to-twin transfusion syndrome (TTTS) or twin anemia-polycythemia sequence (TAPS). In the case of preterm delivery, cesarean section (CS) with immediate umbilical cord clamping (ICC) of both twins is usually performed. While the recipient is at risk for polycythemia and may benefit from ICC, this procedure may result in aggravation of anemia with increased morbidity in the anemic donor. The purpose of this study was to demonstrate that the novel approach of selective extrauterine placental perfusion (EPP) with delayed umbilical cord clamping (DCC) in the donor infant is feasible in neonatal resuscitation of MC twins and may prevent severe anemia in donor and polycythemia in the recipient.
Preterm MC twins with antenatal suspected severe anemia of the donor as measured by Doppler ultrasound, born with birthweights < 1500 g by CS, were transferred to the neonatal resuscitation unit with placenta and intact umbilical cords. In the donor, the umbilical cord was left intact to provide DCC with parallel respiratory support (EPP approach), while the cord of the recipient was clamped immediately after identification.
Selective EPP was performed in three cases of MC twins with TAPS and acute peripartum TTTS. All donor twins had initial hemoglobin levels ≥ 13.0 g/dL, and none of them required red blood cell transfusion on the first day after birth.
Selective EPP may be a feasible strategy for neonatal resuscitation of MC preterm twins with high stage TAPS and TTTS to prevent anemia-related morbidities and may improve infant outcome.
单绒毛膜（MC）双胎有发生严重双胎输血综合征（TTTS）或双胎贫血 - 红细胞增多序列征（TAPS）的风险。对于早产情况，通常会对双胎进行剖宫产（CS）并立即钳夹脐带（ICC）。虽然受血儿有红细胞增多的风险，可能从脐带立即钳夹中获益，但该操作可能会加重贫血供体的贫血状况并增加其发病率。本研究的目的是证明在供体婴儿中采用选择性宫外胎盘灌注（EPP）和延迟脐带钳夹（DCC）的新方法在MC双胎新生儿复苏中是可行的，并且可以预防供体的严重贫血和受血儿的红细胞增多症。
通过多普勒超声产前怀疑供体严重贫血的早产MC双胎，经剖宫产出生体重<1500g，带着胎盘和完整脐带转入新生儿复苏单元。在供体中，保留脐带完整以提供延迟脐带钳夹并给予并行呼吸支持（EPP方法），而受血儿的脐带在识别后立即钳夹。
对3例患有TAPS和急性分娩期TTTS的MC双胎进行了选择性EPP。所有供体双胎出生时初始血红蛋白水平≥13.0g/dL，且出生后第一天均无需输注红细胞。
选择性EPP可能是对患有高分期TAPS和TTTS的MC早产双胎进行新生儿复苏以预防贫血相关并发症的可行策略，并且可能改善婴儿结局。
