Persistent Pulmonary Hypertension of the Newborn in Twin-Twin Transfusion Syndrome: A Case-Control Study
| Autor: | Manon Gijtenbeek, Johanna M. Middeldorp, Enrico Lopriore, Derk Jan Ten Harkel, Arjan B. te Pas, Frans J.C.M. Klumper, Dick Oepkes, Nan van Geloven, Monique C. Haak |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Pediatrics Time Factors Databases Factual medicine.medical_treatment Vasodilator Agents Twin-twin transfusion syndrome Nitric Oxide Persistent Fetal Circulation Syndrome Severity of Illness Index 03 medical and health sciences 0302 clinical medicine Persistent pulmonary hypertension of the newborn Monochorionic twin pregnancy Pregnancy Risk Factors 030225 pediatrics Internal medicine Administration Inhalation medicine Odds Ratio Recipient Humans Fetoscopic laser surgery Risk factor Netherlands Mechanical ventilation 030219 obstetrics & reproductive medicine business.industry Persistent pulmonary hypertension Incidence (epidemiology) Incidence Case-control study Odds ratio Fetofetal Transfusion Twins Monozygotic Respiration Artificial Confidence interval Logistic Models Case-Control Studies Pediatrics Perinatology and Child Health Multivariate Analysis Cardiology Female Monochorionic twins business Developmental Biology |
| Zdroj: | Neonatology, 112(4), 402-408 |
| DOI: | 10.1159/000478844 |
| Popis: | Background: Persistent pulmonary hypertension of the newborn (PPHN) is associated with severe morbidity and mortality. Twin-twin transfusion syndrome (TTTS) is suggested to increase the risk of PPHN. Objectives: To describe the incidence of PPHN in TTTS twins and to identify risk factors in TTTS twins for the development of severe PPHN. Methods: Cases with severe PPHN were extracted from our monochorionic twin database (2002-2016). Severe PPHN was defined as severe hypoxaemia requiring mechanical ventilation and inhaled nitric oxide (iNO) treatment, confirmed by strict echocardiographic criteria. A case-control comparison within TTTS survivors was conducted to identify risk factors for PPHN. Results: The incidence of PPHN in TTTS twins was 4% (24/598, 95% confidence interval [CI] 2.7-5.9%) and 0.4% (2/493, 95% CI 0.1-1.5%) in uncomplicated monochorionic twins (odds ratio [OR] 10.3, 95% CI 2.4-43.9; p = 0.002). Two risk factors were independently associated with PPHN: severe prematurity (OR 3.3, 95% CI 1.0-11.4) and recipient status (OR 3.9, 95% CI 1.4-11.0). In TTTS recipients, another risk factor for PPHN is anaemia at birth (OR 7.2, 95% CI 1.8-29.6). Conclusion: Clinicians caring for neonates with TTTS should be aware of the 10-fold increased risk of PPHN compared to uncomplicated monochorionic twins. PPHN occurs more often in case of premature delivery and in recipient twins, particularly in the presence of anaemia at birth. As the development of severe PPHN is difficult to predict, we advise that all TTTS twins should be delivered in a tertiary care centre with iNO treatment options. |
| Databáze: | OpenAIRE |
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