Abstract
To characterize the neonatal hemodynamic profiles in recipients born after twin-to-twin transfusion syndrome (TTTS) treated with fetoscopic selective laser coagulation (FSLC). Retrospective analysis during the first month of life of recipient twins. Of the 480 newborns born during an 11-year period, 138 recipient twins with prenatal FSLC were classified into four groups: no hemodynamic impairment (NoHI, n = 102, 74%), isolated high blood pressure (HighBP, n = 18, 13%), right ventricular outflow tract obstruction (RVOTO, n = 10, 7%), and cardiac failure (CF, n = 8, 6%). The time (median (IQR)) between FSLC and birth was significantly shorter in the HighBP (36 days (23–54)) and CF (44 days (18–54)) groups than in the RVOTO (91 days (68–112)) and NoHi (82 days (62–104)) groups (p < 0.001).
Conclusion: Four distinct and well-characterized groups of recipients were identified based on their hemodynamics. High blood pressure and heart failure occurred in approximately 20% of the infants and were associated with a time between laser coagulation and birth of less than 2 months.
What is Known: • Twin-to-twin transfusion syndrome (TTTS) is characterized by a hemodynamic imbalance that leads to high fetal and neonatal mortality if left untreated. One-third of recipient twins born without prenatal fetoscopic laser coagulation (FSLC) develop a life-threatening cardiac failure. | |
What is New: • Four distinct groups of recipient twins with prenatal FSLC have been identified based on their hemodynamics. High blood pressure and cardiac failure occurred in 20% of the infants and were associated with an interval between FSLC and birth of less than 2 months. |
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Abbreviations
- CF:
-
Cardiac failure
- FSLC:
-
Fetoscopic selective laser coagulation
- HighBP:
-
High blood pressure
- NoHI:
-
No hemodynamic impairment
- RVOTO:
-
Right ventricular outflow tract obstruction
- TAPS:
-
Twin anemia-polycythemia sequence
- TTTS:
-
Twin-to-twin transfusion syndrome
References
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This study has been supported by the non-profit organization ARFEN. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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EC participated to the conception of the work, the acquisition, the analysis, the interpretation of data for the work, and wrote the manuscript. TH, ES, and CB participated to the acquisition of data for the work and revised manuscript critically for important intellectual content. JS, EKD, PT and YV participated to the interpretation of data for the work and revised manuscript critically for important intellectual content. AL participated to the conception of the work, the interpretation of data for the work and revised manuscript critically for important intellectual content. All authors approved final version of the manuscript and are agree to be accountable for all aspects of the work.
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Not applicable. This is an observational study, not involving the human person, carried out on biological data or samples already collected as part of routine care. The Institutional Review Board of the Assistance Publique-Hôpitaux de Paris has confirmed that no ethical approval is required and has registered the study under the number #20211221172329. In accordance with the reference methodology (MR-004) and the French decree #2017-884 of May 9, 2017 (www.legifrance.gouv.fr/jorf/id/JORFTEXT000034634217), all parents were informed of the possibility of collecting clinical data for research purposes and of their right to refuse such research.
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Communicated by Daniele De Luca
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Chambon, E., Hachem, T., Salvador, E. et al. Neonatal hemodynamics of recipient twins after fetoscopic selective laser coagulation for twin-to-twin transfusion syndrome: An unicist classification. Eur J Pediatr 183, 2501–2505 (2024). https://doi.org/10.1007/s00431-024-05492-9
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DOI: https://doi.org/10.1007/s00431-024-05492-9