CONTRIBUTIONWhat are the novel findings of this work? Donor twins of pregnancies complicated by spontaneous twin anemia-polycythemia sequence (TAPS) have four-fold higher odds of neurodevelopmental impairment compared with their recipient cotwins, are at increased risk of cognitive delay and have a high rate of deafness. What are the clinical implications of this work?Based on our findings, we strongly advise that routine long-term follow-up, including testing for hearing loss, should be an essential part of care of twins diagnosed with spontaneous TAPS. ABSTRACTObjectives To evaluate the long-term neurodevelopmental and behavioral outcomes in surviving infants of pregnancies with spontaneous twin anemia-polycythemia sequence (TAPS), to compare outcome between donors and recipients, and to investigate potential risk factors for neurodevelopmental impairment (NDI).Methods This was a retrospective study of a consecutive cohort of spontaneous-TAPS survivors delivered between 2005 and 2017 at the . Neurological, motor, cognitive and behavioral development were assessed at a median age of 4 years. The primary outcome was NDI, which was a composite outcome of cerebral palsy, deafness, blindness and motor and/or cognitive delay. NDI was subdivided into two grades of severity: mild-to-moderate and severe Correspondence to: Ms L. NDI. Outcome was compared between surviving donor and recipient twins. Logistic regression analysis was used to assess risk factors for NDI.Results Forty-nine twin pregnancies complicated by spontaneous TAPS were eligible for inclusion. The perinatal survival rate was 83% (81/98) of twins. Neurodevelopmental assessment was performed in 91% (74/81) of surviving twins. NDI occurred in 30% (22/74) of TAPS survivors, and was found more often in donors (44%; 15/34) than in recipients (18%; 7/40) (odds ratio (OR), 4.1; 95% CI, 1.8-9.1; P = 0.001). Severe NDI was detected in 9% (7/74) of survivors and was higher in donors compared with recipients (18% (6/34) vs 3% (1/40)), although the difference did not reach statistical significance; P = 0.056). Donors demonstrated lower cognitive scores compared with recipients (P = 0.011). Bilateral deafness was identified in 15% (5/34) of donors compared with 0% (0/40) of recipients (P = 0.056). Parental concern regarding development was reported more often for donor than for recipient twins (P = 0.001). On multivariate analysis, independent risk factors for NDI were gestational age at delivery (OR, 0.7; 95% CI, 0.5-0.9; P = 0.003) and severe anemia (OR, 6.4; 95% CI,; P < 0.001).Conclusion Surviving donor twins of pregnancies complicated by spontaneous TAPS have four-fold higher odds of NDI compared with recipient cotwins, are at increased risk of cognitive delay and have a high rate of deafness.
Objective: To evaluate the cumulative amount of iatrogenic blood loss in extreme preterm infants during the first month of life. Study design: We performed an observational cohort study in 20 extreme preterm infants (gestational age <28 weeks). We recorded the amount of blood drawn for laboratory testing during the first 4 weeks of life, the number of punctures for phlebotomy and intravenous access and the amount of blood loss associated with these procedures. We compared the cumulative blood loss to the estimated total blood volume (85 ml/kg body weight) and to the total volume of red blood cell (RBC) transfusions administered during the same study period. Results: The median cumulative iatrogenic blood loss was 24.2 ml/kg (interquartile range (IQR) 15.8-30.3 ml/kg) per patient, which equals a median of 28.5% (IQR 18.6-35.6%) of the total blood volume. Blood loss was higher in the most extreme preterm infants (30.2 ml/kg at 24 weeks versus 15.9 ml/kg at 27 weeks). The median number of punctures per infant was 47 (IQR 26-56) during the first 4 weeks of life. The median volume of RBC transfusions administered during the study period was 30 ml/kg, slightly more than the cumulative blood loss (24.2 ml/kg). Conclusions: Extreme preterm infants lose almost one-third of their total blood volume in the first month of life as a result of blood loss due to multiple blood draws for laboratory investigations, and procedures.
During oxygen therapy in preterm infants, targeting oxygen saturation is important for avoiding hypoxaemia and hyperoxaemia, but this can be very difficult and challenging for neonatal nurses. We systematically reviewed the qualitative and quantitative studies investigating the compliance in targeting oxygen saturation in preterm infants and factors that influence this compliance. We searched PubMed, Embase, Web of Science, Cochrane, CINAHL and ScienceDirect from 2000 to January 2015. Sixteen studies were selected, which involved a total of 2935 nurses and 574 infants. The studies varied in methodology, and we have therefore used a narrative account to describe the data. The main finding is that there is a low compliance in oxygen targeting; the upper alarm limits are inappropriately set, and maintaining the saturation (SpO2) below the upper limit presented particular difficulties. Although there is little data available, the studies indicate that training, titration protocols and decreasing workload could improve awareness and compliance. Automated oxygen regulations have been shown to increase the time that SpO2 is within the target range.Conclusion: The compliance in targeting oxygen during oxygen therapy in preterm infants is low, especially in maintaining the SpO2 below the upper limit. What is Known: • The use of oxygen in preterm infants is vital, but the optimal strategy remains controversial. • Targeting SpO 2 during oxygen therapy in preterm infants has been shown to reduce mortality and morbidity. What is New:• Review of the literature showed that the compliance in targeting SpO 2 and alarm settings is low. • Creating awareness of risks of oxygen therapy and benefits in targeting, decreasing nurse/patient ratio and automated oxygen therapy could increase compliance.
In preterm infants supported with nCPAP in the neonatal intensive care unit (NICU), SpO₂ ≥95% frequently occurred when oxygen was increased for ABCs and lasted longer than the bradycardia and SpO₂ ≤80%.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.