İkizden İkize Transfüzyon Sendromundan Etkilenmiş Yenidoğanların Erken Dönem Sonuçları

Öz

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.

Anahtar Kelimeler

• 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

Kaynakça

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