Necrotizing Enterocolitis in Premature Twins with Twin-to-Twin Transfusion Syndrome

Abstract

Background: Twin-to-twin transfusion syndrome (TTTS) is a rare but serious clinical constellation that occurs in up to 35 % of monochorionic twin pregnancies. In TTTS, transplacental vascular anastomosis results in a net transfusion from one twin to the other, leading to multiple postnatal complications. We report on two sets of immature twins with TTTS and isolated small bowel perforation with consecutive NEC. Materials and Methods: The gestational age of the male twins was 25 weeks and the gestational age of the female twins was 27 weeks; the mean birth weight was 560 g in the male and 780 g in the female twins. An assessment of the clinical history, including radiological and intraoperative findings and the postmortem examination is given. Results: All 4 infants developed NEC with perforation of the distal ileum. Surgical intervention was performed in all 4 children. Three of the four children died due to complications of TTTS with consecutive NEC and septicemia. Conclusions: The most common explanation for NEC in TTTS is hypoperfusion of the gastrointestinal tract with consecutive hypoxemic damage, especially in the donor twin. In this report, a combination of immaturity and TTTS contributed to intestinal hypoperfusion and concomitant NEC. The pediatric surgeon should be aware of this complication and we recommend proactive surgical management in cases of TTTS.

Key words

twin‐to twin transfusion - fetoscopic laser coagulation - necrotizing enterocolitis - prematurity

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