PDF(Pubmed)
Abstract：
OBJECTIVE: Twins resulting from a complicated monochorionic (MC) twin pregnancy are at risk for postnatal evolution of pulmonary hypertension (PH) and cardiac dysfunction (CD). Both pathologies are important contributors to short- and long-term morbidity in these infants. The aim of the present retrospective single-center cohort study was to evaluate the need for vasoactive treatment for PH and CD in these neonates.
METHODS: In-born neonates following a complicated MC twin pregnancy admitted to the department of neonatology of the University Children\'s Hospital Bonn (UKB) between October 2019 and December 2023 were screened for study inclusion. Finally, 70 neonates were included in the final analysis, with 37 neonates subclassified as recipient twins (group A) and 33 neonates as donor twins (group B).
RESULTS: The overall PH incidence at day of life (DOL) 1 was 17% and decreased to 6% at DOL 7 (p = 0.013), with no PH findings at DOL 28. The overall incidence of CD was 56% at DOL 1 and decreased strongly until DOL 7 (10%, p = 0.015), with no diagnosis of CD at DOL 28. The use of dobutamine, norepinephrine, and vasopressin at DOL 1 until DOL 7 did not differ between the subgroups, whereas the dosing of milrinone was significantly higher in Group B at DOL 1 (p = 0.043). Inhaled nitric oxide (iNO) was used in 16% of the cohort, and a levosimendan therapy was administered in 34% of the neonates. One-third of the cohort was treated with oral beta blockers, and in 10%, an intravenous beta blockade (landiolol) was administered. The maximum levosimendan vasoactive-inotropic score (LVISmax) increased from DOL 1 (12.4 [3/27]) to DOL 2 (14.6 [1/68], p = 0.777), with a significant decrease thereafter as measured at DOL 7 (9.5 [2/30], p = 0.011).
CONCLUSIONS: Early PH and CD are frequent diagnoses in neonates following a complicated MC twin pregnancy, and an individualized vasoactive treatment strategy is required in the management of these infants.
METHODS: In-born neonates following a complicated MC twin pregnancy admitted to the department of neonatology of the University Children\'s Hospital Bonn (UKB) between October 2019 and December 2023 were screened for study inclusion. Finally, 70 neonates were included in the final analysis, with 37 neonates subclassified as recipient twins (group A) and 33 neonates as donor twins (group B).
RESULTS: The overall PH incidence at day of life (DOL) 1 was 17% and decreased to 6% at DOL 7 (p = 0.013), with no PH findings at DOL 28. The overall incidence of CD was 56% at DOL 1 and decreased strongly until DOL 7 (10%, p = 0.015), with no diagnosis of CD at DOL 28. The use of dobutamine, norepinephrine, and vasopressin at DOL 1 until DOL 7 did not differ between the subgroups, whereas the dosing of milrinone was significantly higher in Group B at DOL 1 (p = 0.043). Inhaled nitric oxide (iNO) was used in 16% of the cohort, and a levosimendan therapy was administered in 34% of the neonates. One-third of the cohort was treated with oral beta blockers, and in 10%, an intravenous beta blockade (landiolol) was administered. The maximum levosimendan vasoactive-inotropic score (LVISmax) increased from DOL 1 (12.4 [3/27]) to DOL 2 (14.6 [1/68], p = 0.777), with a significant decrease thereafter as measured at DOL 7 (9.5 [2/30], p = 0.011).
CONCLUSIONS: Early PH and CD are frequent diagnoses in neonates following a complicated MC twin pregnancy, and an individualized vasoactive treatment strategy is required in the management of these infants.
摘要：
目的：复杂的单绒毛膜（MC）双胎妊娠导致的双胎有可能在出生后发展为肺动脉高压（PH）和心功能不全（CD）。两种病理都是这些婴儿短期和长期发病的重要因素。本回顾性单中心队列研究的目的是评估这些新生儿对PH和CD的血管活性治疗的需求。
方法：对在2019年10月至2023年12月期间入住波恩大学儿童医院（UKB）新生儿科的复杂MC双胎妊娠后出生的新生儿进行筛查，以纳入研究。最后,最终分析包括70名新生儿，其中37例新生儿被分类为受体双胞胎（A组），33例新生儿被分类为供体双胞胎（B组）。
结果：生命日（DOL）1的总体PH发生率为17％，在DOL7时下降至6％（p=0.013），在DOL28没有发现PH。在DOL1时，CD的总发病率为56%，直到DOL7(10%，p=0.015),在DOL28时未诊断为CD。多巴酚丁胺的使用，去甲肾上腺素,和血管加压素在DOL1直到DOL7在亚组之间没有差异，而在DOL1时，B组的米力农剂量明显更高（p=0.043）。16％的队列使用了吸入一氧化氮（iNO），34%的新生儿接受了左西孟旦治疗。该队列的三分之一使用口服β受体阻滞剂，在10%中，静脉注射β受体阻滞剂(兰地洛尔).最大左西孟旦血管活性肌力评分（LVISmax）从DOL1（12.4[3/27]）增加到DOL2（14.6[1/68]，p=0.777),此后在DOL7（9.5[2/30]，p=0.011)。
结论：在复杂的MC双胎妊娠后，早期PH和CD是新生儿的常见诊断，在这些婴儿的管理中需要个体化的血管活性治疗策略.
方法：对在2019年10月至2023年12月期间入住波恩大学儿童医院（UKB）新生儿科的复杂MC双胎妊娠后出生的新生儿进行筛查，以纳入研究。最后,最终分析包括70名新生儿，其中37例新生儿被分类为受体双胞胎（A组），33例新生儿被分类为供体双胞胎（B组）。
结果：生命日（DOL）1的总体PH发生率为17％，在DOL7时下降至6％（p=0.013），在DOL28没有发现PH。在DOL1时，CD的总发病率为56%，直到DOL7(10%，p=0.015),在DOL28时未诊断为CD。多巴酚丁胺的使用，去甲肾上腺素,和血管加压素在DOL1直到DOL7在亚组之间没有差异，而在DOL1时，B组的米力农剂量明显更高（p=0.043）。16％的队列使用了吸入一氧化氮（iNO），34%的新生儿接受了左西孟旦治疗。该队列的三分之一使用口服β受体阻滞剂，在10%中，静脉注射β受体阻滞剂(兰地洛尔).最大左西孟旦血管活性肌力评分（LVISmax）从DOL1（12.4[3/27]）增加到DOL2（14.6[1/68]，p=0.777),此后在DOL7（9.5[2/30]，p=0.011)。
结论：在复杂的MC双胎妊娠后，早期PH和CD是新生儿的常见诊断，在这些婴儿的管理中需要个体化的血管活性治疗策略.
