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İkizden İkize Transfüzyon Sendromundan Etkilenmiş Yenidoğanların Erken Dönem Sonuçları

Year 2020, , 128 - 132, 30.09.2020
https://doi.org/10.16948/zktipb.604208

Abstract

Amaç

Monokoryonik
çoğul gebeliklerde gelişen ve hayatı tehdit eden ciddi komplikasyonlara yol
açabilen ikizden ikize transfüzyon sendromu (İİTS)’ndan etkilenmiş infantların
yenidoğan dönemi sonuçlarının değerlendirilmesi amaçlanmıştır. 

Yöntemler

Kliniğimizde Ocak
2013- Aralık 2017 tarihleri arasında izlenen İİTS tanılı olguların demografik
ve klinik verileri geriye dönük değerlendirildi.

Bulgular

Belirlenen
sürede İİTS gelişen 18 ikiz gebelikten 31 bebeğin canlı olarak doğurtulduğu
görüldü. Dört ikiz eşi intrauterin dönemde kaybedilmişti. Dört gebeye lazer
fotokoagulasyon uygulanmış ve bu gebeliklerden ikisinde verici ikiz intrauterin
dönemde kaybedilmişti. Olguların 17’si alıcı, 14’ü verici ikizdi. Olguların
doğum tartıları 1346±654 gram, gebelik haftaları 30,1±3,7 hafta idi. İki olguda
hidrops fetalis saptandı. Verici ikizlerin hemoglobin ve hematokrit değerleri
alıcı ikizlere göre anlamlı olarak daha düşük; ölüm oranları ise anlamlı olarak
daha yüksek saptandı (sırasıyla p=0,0001; 0,0001; 0,018). İki olguya anemi,
altı olguya polisitemi nedeni ile kan değişimi yapıldı. Alıcı ve verici ikizler
arasında doğum tartıları, respiratuvar distres sendromu, patent duktus arteriosus,
bronkopulmoner displazi, prematürite retinopatisi ve nekrotizan enterokolit
gelişimi; solunum desteği ve inotrop ihtiyacı açısından anlamlı fark
saptanmadı. Alıcı olguların üçünde kardiak hipertrofi saptandı. Bir alıcı
ve üç verici olguda böbrek yetmezliği gelişti. Verici olguların dördü, alıcı
olguların biri kaybedildi. Yirmi
bir olgu şifa ile taburcu edildi.

Sonuç















İkiz gebeliklerin yakın
takibi, erken doğumun önlenmesi ve İİTS tanılı bebeklerin karşılaşacağı İİTS’ye
özgü sorunların farkında olunması bu bebekler için hayati önem taşımaktadır.

References

  • Referans 1. Bliss JM, Carr SR, De Paepe ME, Luks FI. What—andWhy—the Neonatologist Should Know About Twin-To-Twin Transfusion Syndrome. Neo Reviews 2017; 18: 22-32.
  • Referans 2. Emery SP, Hasley SK, Catov JM, Miller RS, Moon-Grady AJ, Baschat AA, et al. North American Fetal Therapy Network. North American Fetal Therapy Network: intervention vs expectant management for stage I twin-twin transfusion syndrome. Am J Obstet Gynecol 2016; 215: 1-7.
  • Referans 3. Hecher K, Diehl W, Zikulnig L, Vetter M, Hackelöer BJ. Endoscopic laser coagulation of placental anastomoses in 200 pregnancies with severe mid-trimester twin-to-twin transfusion syndrome. Eur J Obstet Gynecol Reprod Biol 2000; 92: 135-9.
  • Referans 4. Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M. Staging of twin-twin transfusion syndrome. J Perinatol 1999; 19: 550-5.
  • Referans 5. Slaghekke F, Kist WJ, Oepkes D, Middeldorp JM, Klumper FJ, Vandenbussche FP, et al. TAPS and TOPS: two distinct forms of feto-fetal transfusion in monochorionic twins. Z Geburtshilfe Neonatol 2009; 213: 248-54.
  • Referans 6. Chmait RH, Quintero RA. Operativefetoscopy in complicated monochorionic twins: current status and future direction. Curr Opin Obstet Gynecol 2008; 20: 169-74.
  • Referans 7. De Paepe ME, Stopa E, Huang C, Hansen K, Luks FI. Renal tubular apoptosis in twin-to-twin transfusion syndrome. Pediatr Dev Pathol 2003; 6: 215-25.
  • Referans 8. SenatMV, Deprest J, Boulvain M, PaupeA,Winer N, Ville Y. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med 2004; 351: 136-44.
  • Referans 9. Khalek N, Johnson MP, Bebbington MW. Fetoscopic laser therapy for twin-to-twin transfusion syndrome. Semin Pediatr Surg 2013; 22: 18-23.Referans 10. De Paepe ME, Friedman RM, Poch M, Hansen K, Carr SR, Luks FI. Placental findings after laser ablation of communicating vessels in twin-to-twin transfusion syndrome. Pediatr Dev Pathol 2004; 7: 159-65.
  • Referans 11. Muratore CS, Carr SR, Lewi L, Delieger R, Carpenter M, Jani J, et al. Survival after laser surgery for twin-to-twin transfusion syndrome: when are they out of the woods? J Pediatr Surg 2009; 44: 66-9.
  • Referans 12. Rossi AC, Vanderbilt D, Chmait RH. Neurodevelopmental outcomes after laser therapy for twin-twin transfusion syndrome: a systematic review and meta-analysis. Obstet Gynecol 2011; 118: 1145-50
  • Referans 13. Kowitt B, Tucker R, Watson-Smith D, Muratore CS, O'Brien BM, Vohr BR, et al. Long-term morbidity after fetal endoscopic surgery for severe twin-to-twin transfusion syndrome. J Pediatr Surg 2012; 47: 51-6.
  • Referans 14. Lenclen R, Ciarlo G, Paupe A, Bussieres L, Ville Y. Neurodevelopmental outcome at 2 years in children born preterm treated by amnioreduction or fetoscopic laser surgery for twin-to-twintransfusion syndrome: comparison with dichorionic twins. Am J Obstet Gynecol 2009; 201: 1-5.
  • Referans 15. Dickinson JE, Duncombe GJ, Evans SF, French NP, Hagan R. The long term neurologic outcome of children from pregnancies complicated by twin-to-twin transfusion syndrome. BJOG 2005; 112: 63-8.
  • Referans 16. Carr SR, Luks F, Tracy T, Plevyak M. Antenatal necrotic injury in severe twin-to-twin transfusion syndrome: a case and review. Fetal Diagn Ther 2004; 19: 370-72.
  • Referans 17. Lopriore E, Lewi L, Oepkes D, Debeer A, Vandenbussche FP, Deprest J, et al. In utero acquired limb ischemia in monochorionic twins with and without twin-to-twin transfusion syndrome. Prenat Diagn 2008; 28: 800-4.Referans 18. O’Donoghue K, Rutherford MA, Engineer N, Wimalasundera RC, Cowan FM, Fisk NM. Transfusional fetal complications after single intrauterine death in monochorionic multiple pregnancy are reduced but not prevented by vascular occlusion. BJOG 2009; 116: 804-12.
  • Referans 19. Ortibus E, Lopriore E, Deprest J, Vandenbussche FP, Walther FJ, Diemert A, et al. The pregnancy and long-term neurodevelopmental outcome of monochorionic diamniotic twin gestations: a multicenter prospective cohort study from the first trimester onward. Am J Obstet Gynecol 2009; 200: 1-8.
  • Referans 20. O’Donoghue K, Cartwright E, Galea P, Fisk NM. Stage I twin-twin transfusion syndrome: rates of progression and regression in relation to outcome. Ultrasound Obstet Gynecol 2007; 30: 958-64.
  • Referans 21. Luks FI, Carr SR, Plevyak M, Craigo SD, Athanassiou A, Ralston SJ, et al. Limited prognostic value of a staging system for twin-to-twin transfusion syndrome. Fetal Diagn Ther 2004; 19: 301-4.
  • Referans 22. Dickinson JE, Evans SF. The progression of disease stage in twin-twin transfusion syndrome. J Matern Fetal Neonatal Med 2004; 16: 95-101.

Early Results of Newborns Affected by Twin to Twin Transfusion Syndrome

Year 2020, , 128 - 132, 30.09.2020
https://doi.org/10.16948/zktipb.604208

Abstract

Introduction

The
aim of this study was to evaluate the results of neonatal period of infants
affected by twin-to-twin transfusion syndrome (TTTS), which may lead to serious
life-threatening complications in monochorionic multiple pregnancies.

Methods

The
demographic and clinical data of the cases diagnosed with TTTS in our clinic
between January 2013 and December 2017 were evaluated retrospectively.

Results

Thirty-one
infants born to 18 twin pregnancies who developed TTTS were delivered alive.
One fetus of four twin couples had died in intrauterine period. Four pregnant
women underwent laser photocoagulation, the two donor twins of these  pregnancies died during intrauterine period.
Seventeen cases were recipient and 14 were donor twins. The birth weights of
the cases were 1346±654 grams and the gestational weeks were 30.1±3.7 weeks.
Hydrops were detected in two cases. The hemoglobin and hematocrit values ​​of
donor twins were significantly lower; mortality rates were significantly higher
than the recipient twins (p = 0.0001;0.0001;0.018, respectively). Exchange
transfusion was done to two patients for anemia and six patients for
polycythemia. No significant difference was found between donor and recipient
twins in terms of birth weight, respiratory distress syndrome, patent ductus
arteriosus, bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing
enterocolitis; respiratory support and inotropic need. Cardiac hypertrophy was
detected in three of the recipient cases. One recipient and three donor cases
developed renal failure. Four donor cases, one recipient case were lost.
Twenty-one cases were discharged with healing.

Conclusion















Close
follow-up of twin pregnancies, prevention of preterm birth and awareness of TTTS
specific problems encountered by babies with TTTS are vital for these babies.

References

  • Referans 1. Bliss JM, Carr SR, De Paepe ME, Luks FI. What—andWhy—the Neonatologist Should Know About Twin-To-Twin Transfusion Syndrome. Neo Reviews 2017; 18: 22-32.
  • Referans 2. Emery SP, Hasley SK, Catov JM, Miller RS, Moon-Grady AJ, Baschat AA, et al. North American Fetal Therapy Network. North American Fetal Therapy Network: intervention vs expectant management for stage I twin-twin transfusion syndrome. Am J Obstet Gynecol 2016; 215: 1-7.
  • Referans 3. Hecher K, Diehl W, Zikulnig L, Vetter M, Hackelöer BJ. Endoscopic laser coagulation of placental anastomoses in 200 pregnancies with severe mid-trimester twin-to-twin transfusion syndrome. Eur J Obstet Gynecol Reprod Biol 2000; 92: 135-9.
  • Referans 4. Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M. Staging of twin-twin transfusion syndrome. J Perinatol 1999; 19: 550-5.
  • Referans 5. Slaghekke F, Kist WJ, Oepkes D, Middeldorp JM, Klumper FJ, Vandenbussche FP, et al. TAPS and TOPS: two distinct forms of feto-fetal transfusion in monochorionic twins. Z Geburtshilfe Neonatol 2009; 213: 248-54.
  • Referans 6. Chmait RH, Quintero RA. Operativefetoscopy in complicated monochorionic twins: current status and future direction. Curr Opin Obstet Gynecol 2008; 20: 169-74.
  • Referans 7. De Paepe ME, Stopa E, Huang C, Hansen K, Luks FI. Renal tubular apoptosis in twin-to-twin transfusion syndrome. Pediatr Dev Pathol 2003; 6: 215-25.
  • Referans 8. SenatMV, Deprest J, Boulvain M, PaupeA,Winer N, Ville Y. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med 2004; 351: 136-44.
  • Referans 9. Khalek N, Johnson MP, Bebbington MW. Fetoscopic laser therapy for twin-to-twin transfusion syndrome. Semin Pediatr Surg 2013; 22: 18-23.Referans 10. De Paepe ME, Friedman RM, Poch M, Hansen K, Carr SR, Luks FI. Placental findings after laser ablation of communicating vessels in twin-to-twin transfusion syndrome. Pediatr Dev Pathol 2004; 7: 159-65.
  • Referans 11. Muratore CS, Carr SR, Lewi L, Delieger R, Carpenter M, Jani J, et al. Survival after laser surgery for twin-to-twin transfusion syndrome: when are they out of the woods? J Pediatr Surg 2009; 44: 66-9.
  • Referans 12. Rossi AC, Vanderbilt D, Chmait RH. Neurodevelopmental outcomes after laser therapy for twin-twin transfusion syndrome: a systematic review and meta-analysis. Obstet Gynecol 2011; 118: 1145-50
  • Referans 13. Kowitt B, Tucker R, Watson-Smith D, Muratore CS, O'Brien BM, Vohr BR, et al. Long-term morbidity after fetal endoscopic surgery for severe twin-to-twin transfusion syndrome. J Pediatr Surg 2012; 47: 51-6.
  • Referans 14. Lenclen R, Ciarlo G, Paupe A, Bussieres L, Ville Y. Neurodevelopmental outcome at 2 years in children born preterm treated by amnioreduction or fetoscopic laser surgery for twin-to-twintransfusion syndrome: comparison with dichorionic twins. Am J Obstet Gynecol 2009; 201: 1-5.
  • Referans 15. Dickinson JE, Duncombe GJ, Evans SF, French NP, Hagan R. The long term neurologic outcome of children from pregnancies complicated by twin-to-twin transfusion syndrome. BJOG 2005; 112: 63-8.
  • Referans 16. Carr SR, Luks F, Tracy T, Plevyak M. Antenatal necrotic injury in severe twin-to-twin transfusion syndrome: a case and review. Fetal Diagn Ther 2004; 19: 370-72.
  • Referans 17. Lopriore E, Lewi L, Oepkes D, Debeer A, Vandenbussche FP, Deprest J, et al. In utero acquired limb ischemia in monochorionic twins with and without twin-to-twin transfusion syndrome. Prenat Diagn 2008; 28: 800-4.Referans 18. O’Donoghue K, Rutherford MA, Engineer N, Wimalasundera RC, Cowan FM, Fisk NM. Transfusional fetal complications after single intrauterine death in monochorionic multiple pregnancy are reduced but not prevented by vascular occlusion. BJOG 2009; 116: 804-12.
  • Referans 19. Ortibus E, Lopriore E, Deprest J, Vandenbussche FP, Walther FJ, Diemert A, et al. The pregnancy and long-term neurodevelopmental outcome of monochorionic diamniotic twin gestations: a multicenter prospective cohort study from the first trimester onward. Am J Obstet Gynecol 2009; 200: 1-8.
  • Referans 20. O’Donoghue K, Cartwright E, Galea P, Fisk NM. Stage I twin-twin transfusion syndrome: rates of progression and regression in relation to outcome. Ultrasound Obstet Gynecol 2007; 30: 958-64.
  • Referans 21. Luks FI, Carr SR, Plevyak M, Craigo SD, Athanassiou A, Ralston SJ, et al. Limited prognostic value of a staging system for twin-to-twin transfusion syndrome. Fetal Diagn Ther 2004; 19: 301-4.
  • Referans 22. Dickinson JE, Evans SF. The progression of disease stage in twin-twin transfusion syndrome. J Matern Fetal Neonatal Med 2004; 16: 95-101.
There are 20 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Original Research
Authors

Aslı Okbay Güneş 0000-0003-4041-0648

Sevilay Topçuoğlu

Nilgün Karadağ

Elif Özalkaya

Güner Karatekin This is me

Publication Date September 30, 2020
Published in Issue Year 2020

Cite

APA Okbay Güneş, A., Topçuoğlu, S., Karadağ, N., Özalkaya, E., et al. (2020). İkizden İkize Transfüzyon Sendromundan Etkilenmiş Yenidoğanların Erken Dönem Sonuçları. Zeynep Kamil Tıp Bülteni, 51(3), 128-132. https://doi.org/10.16948/zktipb.604208
AMA Okbay Güneş A, Topçuoğlu S, Karadağ N, Özalkaya E, Karatekin G. İkizden İkize Transfüzyon Sendromundan Etkilenmiş Yenidoğanların Erken Dönem Sonuçları. Zeynep Kamil Tıp Bülteni. September 2020;51(3):128-132. doi:10.16948/zktipb.604208
Chicago Okbay Güneş, Aslı, Sevilay Topçuoğlu, Nilgün Karadağ, Elif Özalkaya, and Güner Karatekin. “İkizden İkize Transfüzyon Sendromundan Etkilenmiş Yenidoğanların Erken Dönem Sonuçları”. Zeynep Kamil Tıp Bülteni 51, no. 3 (September 2020): 128-32. https://doi.org/10.16948/zktipb.604208.
EndNote Okbay Güneş A, Topçuoğlu S, Karadağ N, Özalkaya E, Karatekin G (September 1, 2020) İkizden İkize Transfüzyon Sendromundan Etkilenmiş Yenidoğanların Erken Dönem Sonuçları. Zeynep Kamil Tıp Bülteni 51 3 128–132.
IEEE A. Okbay Güneş, S. Topçuoğlu, N. Karadağ, E. Özalkaya, and G. Karatekin, “İkizden İkize Transfüzyon Sendromundan Etkilenmiş Yenidoğanların Erken Dönem Sonuçları”, Zeynep Kamil Tıp Bülteni, vol. 51, no. 3, pp. 128–132, 2020, doi: 10.16948/zktipb.604208.
ISNAD Okbay Güneş, Aslı et al. “İkizden İkize Transfüzyon Sendromundan Etkilenmiş Yenidoğanların Erken Dönem Sonuçları”. Zeynep Kamil Tıp Bülteni 51/3 (September 2020), 128-132. https://doi.org/10.16948/zktipb.604208.
JAMA Okbay Güneş A, Topçuoğlu S, Karadağ N, Özalkaya E, Karatekin G. İkizden İkize Transfüzyon Sendromundan Etkilenmiş Yenidoğanların Erken Dönem Sonuçları. Zeynep Kamil Tıp Bülteni. 2020;51:128–132.
MLA Okbay Güneş, Aslı et al. “İkizden İkize Transfüzyon Sendromundan Etkilenmiş Yenidoğanların Erken Dönem Sonuçları”. Zeynep Kamil Tıp Bülteni, vol. 51, no. 3, 2020, pp. 128-32, doi:10.16948/zktipb.604208.
Vancouver Okbay Güneş A, Topçuoğlu S, Karadağ N, Özalkaya E, Karatekin G. İkizden İkize Transfüzyon Sendromundan Etkilenmiş Yenidoğanların Erken Dönem Sonuçları. Zeynep Kamil Tıp Bülteni. 2020;51(3):128-32.