Twin-to-twin transfusion syndrome: Is the future getting brighter?

Twin-to-twin transfusion syndrome: perinatal outcome and recipient heart disease according to treatment strategy

AIM

The aims of the study were to compare perinatal outcome and assess recipient cardiac disease according to treatment strategy (amnioreduction (AR), laser or selective feticide).

METHODS

We retrospectively reviewed 81 consecutive cases of twin-to-twin transfusion syndrome diagnosed before 28 weeks between 1993 and 2007.

RESULTS

Although fetuses treated by laser were younger at diagnosis (median 20.4 vs. 22.4 weeks, P = 0.01), they were significantly older at birth (median 33.6 vs. 28.5 weeks, P = 0.004) than those treated by AR. Neonatal morbidity was globally lower after laser than AR, and cardiac insufficiency tended to be less frequent (31% vs. 57%, P = 0.09). There was a trend towards increased perinatal survival after laser treatment (68% vs. 49%, P = 0.1). Heart failure was the cause of death in half (23/46) of the recipients. Fetal heart failure leading to death was 2.7 times more frequent after AR than after laser (n = 11 vs. n = 4), and all four neonatal cardiac deaths occurred after AR. Compared with laser, selective feticide did not further improve the outcome.

CONCLUSIONS

Heart failure was an important cause of perinatal morbidity and death. However, laser therapy resulted in a longer diagnosis-delivery interval and lower global neonatal morbidity than AR, with a trend towards increased perinatal survival. Improved outcome after laser treatment compared with AR might be related to its impact on recipient heart disease.

Kangaroo care with twins: a case study in which one infant did not respond as expected

PURPOSE

The purposes were to relate responses (including unacceptable ones) of twins to shared kangaroo care (KC), to provide explanations for the unexpected responses, and to offer suggestions for safe nursing practice.

DESIGN

A descriptive, evaluative case study was conducted. Both twins received KC while their vital signs and maternal breast temperatures were manually recorded every 30 seconds. Descriptive statistics were computed.

SAMPLE

Identical twins, born to a 19-year-old African-American primigravada, were 34 3/7 weeks postconceptional age with weights of 1,760 and 1,480 g, respectively, when tested. Preterm labor resulted in spontaneous vaginal birth at 30 weeks gestation.

MAIN OUTCOME VARIABLES

Infant heart and respiratory rates, oxygen saturations, abdominal temperatures, and maternal breast temperatures.

RESULTS

Infant A's vital signs exceeded acceptable clinical limits during shared KC; vital signs returned to normal range once Infant A was returned to the incubator. Infant B's vital signs approximated clinically acceptable ranges throughout the session. Breast temperatures did not differ. Individuality mandates vigilant assessment of infant responses to shared KC.