Clinical Study On The Outcome Of Newborns With Twin Transfusion Syndrome

Objective:Twin transfusion syndrome(TTTS)caused by the imbalance of blood perfusion between monochorionic twins,is one of the most serious complications of monochorionic twins,accounting for 5% to 15% of monochorionic twins.If left untreated,the perinatal mortality of TTTS is as high as 80% to 100%.In recent years,with the development of prenatal diagnosis and prenatal intervention technology,the perinatal survival rate of TTTS has been significantly improved,but the outcome of surviving TTTS newborns is still not optimistic,especially TTTS combined with fetal death(Single intrauterine fetal demise,sIUFD)leads to multiple organ function damage and even death or severe neurological sequelae.This study analyzed the clinical data of TTTS newborns delivered in the third affiliated Hospital of Zhengzhou University and transferred to the Department of Neonatology from January 2017 to September 2020.To analyze their fetal condition,systemic complications and death in the neonatal period,in order to strengthen the neonatal monitoring and intervention of TTTS infants and improve their long-term quality of life.Methods:The clinical data of 99 pairs of TTTS newborns delivered in the third affiliated Hospital of Zhengzhou University from 2017.01 to 2020.09 and transferred to the Department of Neonatal Pediatrics were collected,including 10 cases of intrauterine fetal death.100 pairs of non-TTTS twins in the same gestational age group were selected as the control group,and the TTTS group was divided into two groups according to the severity of the disease,blood donors and blood recipients.The differences of general condition,incidence of very low birth weight,incidence of neonatal asphyxia and mortality between TTTS group and non-TTTS group were analyzed,and the incidences of circulatory system,respiratory system,digestive system,nervous system complications,blood coagulation function and renal function damage between mild TTTS group and severe TTTS group,blood donor group and blood recipient group were analyzed,and the clinical characteristics and prognosis of10 cases of fetal death were summarized.SPSS26.0 software was used for statistical analysis of the data.The counting data were expressed by the number of cases(%),and the chi-square test or Fisher exact probability method was used for comparison between groups.The measurement data in accordance with normal distribution are expressed by mean±standard deviation(x ±s),and group t-test is used for comparison between groups.The difference was statistically significant(P < 0.05).Results:1.In general:In the TTTS group,the average gestational age was(32.64 ±2.72)weeks,the average body weight was(1657.63 ±543.80)g,the proportion of very low birth weight infants was 44.7%(84x188),the average birth weight of the control group was(1758.71 ±354.13)g,and the proportion of very low birth weight infants was 26%.The birth weight of 52),TTTS group was lower than that of the control group,and the ratio of very low birth weight infants was higher than that of twins of the same gestational age.The incidence and mortality of neonatal asphyxia in TTTS group were significantly higher than those in control group.2.Comparison of the incidence of systemic complications in different groups:Compared with blood donors,blood recipients were more likely to be complicated with circulatory complications,including atrioventricular valve regurgitation,patent ductus arteriosus and pulmonary valve stenosis / atresia(P < 0.05).The incidence of neonatal asphyxia and necrotizing enterocolitis in blood donor group was significantly higher than that in blood donor group(P < 0.05).The incidence of neonatal asphyxia and necrotizing enterocolitis in blood donor group was significantly higher than that in blood donor group(P < 0.05).There was no significant difference in the incidence of various types of cardiovascular complications between mild and severe TTTS groups,but the incidences of neonatal asphyxia and coagulation dysfunction in severe TTTS group were significantly higher than those in mild TTTS group(P < 0.05).There was no significant difference in the incidence of acute renal injury and brain injury between severe TTTS group and mild TTTS group.3.Main cause of death: 26 cases(13.8%)died of TTTS during hospitalization.The common causes of death were severe craniocerebral injury(7/26.9%),septicemia with multiple organ failure(5/19.2%),neonatal respiratory distress syndrome/pulmonary hemorrhage and respiratory failure(5/19.2%),severe pulmonary valve stenosis/atresia(3/11.5%),gastrointestinal perforation(3/11.5%),genetic metabolic disease(1/3.8%)and others(2/7.7%).4.Clinical characteristics of the children TTTS complicated with sIUFD:Children may have multiple system complications such as respiratory system,circulatory system,nervous system and blood system,and the incidence of persistent pulmonary hypertension and abnormal blood coagulation is high.Neurological follow-up of 8 discharged children showed that 3 cases(37.5%)had severe neurodevelopmental abnormalities,2 cases of cerebral palsy and 1 case of motor retardation.Conclusion:1.The incidence of very low birth weight,neonatal asphyxia and mortality of TTTS newborns are higher than those of non-TTTS twins of the same gestational age.2.Recipients are prone to circulatory complications such as atrioventricular regurgitation,patent ductus arteriosus and pulmonary valve stenosis / atresia,and blood donors are prone to neonatal asphyxia and necrotizing enterocolitis.Severe TTTS group is more likely to develop neonatal asphyxia and abnormal blood coagulation than mild TTTS group.3.The main causes of death in newborns with twin transfusion syndrome were severe brain injury,septicemia with multiple organ failure,neonatal respiratory distress syndrome / pulmonary hemorrhage,severe pulmonary valve stenosis / atresia and gastrointestinal perforation.4.There is a high risk of severe neurological sequelae in the intrauterine survivors of fetal death in the third trimester.Perinatal monitoring and intervention of TTTS should be strengthened to improve the long-term quality of life of TTTS newborns.