单绒毛膜双胎宫外选择性胎盘灌注是可行的--系列病例

IF 2 4区 医学 Q2 PEDIATRICS
Benjamin Kuehne, Jan Trieschmann, Sarina Kim Butzer, Katrin Mehler, Ingo Gottschalk, Angela Kribs, André Oberthuer
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引用次数: 0

摘要

背景:单绒毛膜双胎(MC)有可能发生严重的双胎输血综合征(TTTS)或双胎贫血多血症序列(TAPS)。在早产的情况下,通常会对双胞胎进行剖宫产(CS)并立即进行脐带夹闭(ICC)。虽然受体有多血症的风险并可能从 ICC 中获益,但这一过程可能会导致贫血加重,增加贫血供体的发病率。本研究的目的是证明,在 MC 双胎的新生儿复苏中,对供体婴儿进行选择性宫外胎盘灌注(EPP)并延迟脐带夹闭(DCC)的新方法是可行的,而且可以防止供体的严重贫血和受体的多血症:方法:多普勒超声检查发现,早产 MC 双胎的供体存在严重贫血,经 CS 出生,出生体重小于 1500 克,带胎盘和完整脐带转入新生儿复苏室。供体的脐带保持完整,以提供并行呼吸支持的 DCC(EPP 方法),而受体的脐带在确认后立即被夹住:对三例患有 TAPS 和急性围产期 TTTS 的 MC 双胎进行了选择性 EPP。所有供体双胞胎的初始血红蛋白水平均≥13.0 g/dL,且无一例在出生后第一天需要输注红细胞:结论:选择性EPP可能是一种可行的新生儿复苏策略,适用于高龄TAPS和TTTS的MC早产双胞胎,可预防贫血相关的疾病,并可改善婴儿的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Selective Extrauterine Placental Perfusion in Monochorionic Twins Is Feasible-A Case Series.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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来源期刊
Children-Basel
Children-Basel PEDIATRICS-
CiteScore
2.70
自引率
16.70%
发文量
1735
审稿时长
6 weeks
期刊介绍: Children is an international, open access journal dedicated to a streamlined, yet scientifically rigorous, dissemination of peer-reviewed science related to childhood health and disease in developed and developing countries. The publication focuses on sharing clinical, epidemiological and translational science relevant to children’s health. Moreover, the primary goals of the publication are to highlight under‑represented pediatric disciplines, to emphasize interdisciplinary research and to disseminate advances in knowledge in global child health. In addition to original research, the journal publishes expert editorials and commentaries, clinical case reports, and insightful communications reflecting the latest developments in pediatric medicine. By publishing meritorious articles as soon as the editorial review process is completed, rather than at predefined intervals, Children also permits rapid open access sharing of new information, allowing us to reach the broadest audience in the most expedient fashion.
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