İkizden İkize Transfüzyon Sendromundan Etkilenmiş Yenidoğanların Erken Dönem Sonuçları

Year 2020, , 128 - 132, 30.09.2020

Aslı Okbay Güneş , Sevilay Topçuoğlu , Nilgün Karadağ , Elif Özalkaya , Güner Karatekin

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.

Keywords

İkizden ikize transfüzyon, lazer fotokoagulasyon, prematürite, Quintero evrelemesi, yenidoğan

Early Results of Newborns Affected by Twin to Twin Transfusion Syndrome

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.

Keywords

Twin to twin transfusion, laser photocoagulation, prematurity, Quintero staging, newborn

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