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Large cupping of the optic disk in a baby or a child can be indicative of primary congenital glaucoma. Primary congenital glaucoma is often refractory to treatment, and lifelong management and follow-up are necessary; therefore, diagnosis requires careful consideration. In this study, we describe the case of twins in whom primary congenital glaucoma was initially suspected due to large cupping of the optic disks. Twin babies (a boy and a girl weighing 455 g and 592 g respectively), born prematurely (at 28 gestational weeks), were referred to our hospital eight months after birth because large cupping of the optic disks was detected during follow-up for retinopathy of prematurity. According to color fundus photographs, the cup/disk ratios in both eyes of both babies ranged from 0.75 to 0.86. However, the axial length ranged from 18.57 to 19.91 mm, the anterior chamber depth ranged from 2.68 to 2.93 mm, and the horizontal diameters of the corneas, which were clear, ranged from 10 to 10.5 mm. The intraocular pressures (IOPs), as measured by a rebound tonometer, were 15.3-19.7 mmHg. Glaucoma was strongly suspected due to the large cupping of the optics disks; however, other ocular biometric tests demonstrated that the eyes were normal. After eight months of follow-up without any medication or intervention, the IOPs stabilized between 6-22.1 mmHg, the refractive errors were between -2.5 and 0 diopters, and we found no apparent enlargement of the optic disks. In addition, we investigated both parents’ optic disks to evaluate the genetic factors and found that they had relatively large C/D ratios (0.68-0.79). These premature twins exhibited glaucoma-like optic disks with large cupping, but no solid glaucomatous changes were observed with ocular biometry and IOP testing. We concluded, therefore, that the early birth and lower birth weights may have been associated with the large cupping of the patients’ optic disks. To differentiate between normal physiological cupping and primary congenital glaucoma, ocular morphological examination of the eye, IOP measurements, and investigation of the parents’ optic disks were useful.

Background: Limited details are available regarding the vertical transmission potential of COVID-19 infection in pregnant women. The authors' current study aimed to report the vertical transmission potential of COVID-19 infection in a woman pregnant with twins. Case description: The authors report the case of a 27-year-old woman infected with SARS-CoV-2. The patient was pregnant with dichorionic diamniotic fraternal twins and admitted to Renmin Hospital of Wuhan University, Wuhan, China. After undergoing a cesarean section, the patient gave birth to premature twins, who tested positive for COVID-19 infection. Interpretation: Findings from this case suggest a possibility of intrauterine infection caused by vertical transmission in a woman infected with COVID-19.

For today, twins make up about 1.5% of the population of our planet. It is more than one hundred million people, which in number corresponds to the population of two Frances. The number of twins born relative to the total number of newborns in different countries and on different continents is different, but the overall trend is that it continues to grow. In recent years, the percentage of multiple pregnancy has increased almost 2.5 times, which is associated with the widespread use of assisted reproductive technologies.At the same time, pregnancy in multiple births is an extremely important problem in modern obstetrics, as it is accompanied by a high level of complications for both the mother and the fetuses. Multiple pregnancy contributes significantly to the formation of adverse perinatal outcomes, which is primarily due to the high rate of preterm birth. Premature twins are at high risk of neurological and neuropsychiatric disorders, respiratory distress, endocrine and metabolic disorders, which subsequently become the cause of disability and social maladaptation of children. In this regard, the reduction in the number of premature births is today a priority task, the solution of which is possible only through timely and correct forecasting. The multifactority of pathogenic mechanisms determines the necessity of diagnostic search strategies that can identify markers of various pathogenetic ways of preterm birth. (For citation: Kosyakova OV, Bespalova ОN. Challenges and prospects of preterm birth prediction in multiple pregnancies. Journal of Obstetrics and Women’s Diseases. 2018;67(4):48-59. doi: 10.17816/JOWD67448-59).

Introduction: Neonatal Graves’ disease (NGD) occurs in approximately 1-5% of infants born to women with Graves’ disease. It is caused by trans-placental crossing of thyroid stimulating immunoglobulin (TSI) antibodies during third trimester. Hyperthyroidism during pregnancy can lead to craniosynostosis, goiter, premature bone maturation, developmental delay or even heart failure in the neonate. Neonatal Hyperthyroidism is usually transient and resolves in few weeks. Treatment consists of beta blockers and Methimazole. Studies in adults recommend discontinuing of Methimazole if patients develop neutropenia. However due to lack of alternatives, we present a case of continued use of Methimazole with neutropenia in newborn twins. Case Report: 33 weeks gestational age mono-chorionic/di-amniotic twins born to a 34-year-old woman with poorly controlled hyperthyroidism. Mother diagnosed with Graves’ disease during 2nd trimester with poor control throughout pregnancy. At the time of delivery, maternal TSH was 700%. Baseline CBC showed ANC of 4.95K/mm3. Babies were started on Methimazole 0.5mg/kg/day and Propranolol 2mg/kg/day. TFTs fluctuated throughout their stay in NICU and they developed neutropenia with ANC 1.23K/mm3 on day 20 of life. Methimazole was initially discontinued then restarted at 0.25 mg/kg/day 3 days later. There is no recommended protocol for restarting Methimazole. Further follow up showed persistent neutropenia despite multiple dose adjustments in Methimazole, including dosing every other day. ANC was maintained around 800-1100K/mm3. At age 2 months, Methimazole was discontinued completely after TSI antibodies decreased to 400%. ANC remained low until 6 months of life, even after discontinuing Methimazole. Both babies ultimately developed central hypothyroidism and were started on l-thyroxine. Discussion: NGD can range anywhere from transient hyperthyroidism to persistent central hypothyroidism. Early diagnosis and treatment is crucial to prevent significant morbidity and mortality. Methimazole is the only approved treatment at this age, and management of Methimazole-induced neutropenia has not been established. Adult studies recommend discontinuing Methimazole in context of neutropenia; we took an approach of decreasing dose gradually. Further studies are needed to establish step-wise approach in managing Methimazole-induced neutropenia.

Introduction Autosomal dominant hypophosphatemic rickets (ADHR) is a condition with variable phenotype in terms of age of presentation, severity, and possible resolution. ADHR is caused by mutations of FGF23, preventing its cleavage, producing high levels of FGF23, which leads to renal phosphate wasting. Studies in mice and adult humans, have shown a correlation between low iron levels and increased FGF23 levels. To our knowledge, three pediatric patients with ADHR resolved with iron supplementation have been reported in the literature. Clinical case We report on identical twins born at 28 weeks and 5 days by cesarean section due to premature rupture of membranes with complicated pregnancy due to twin-to-twin transfusion syndrome. Birth weights were 780 grams (2nd percentile) for twin A, 1,200 grams (50th percentile) for twin B. Hypophosphatemia was documented starting at 2 weeks of life and during the first 6 of months of life, with phosphorus levels between 2.9-3.9 mg/dL for twin A and between 2.4-5.1 mg/dL for twin B. During their NICU admission phosphorus had a positive relationship with the hemoglobin level, which was more severe on twin A. Both were treated with calcitriol and a low dose of phosphorus starting on their 2nd month of life. At 6 months of age, both had persistent hypophosphatemia, more prominently in twin A (2.7mg/dL) with high alkaline phosphatase (1,209 IU/L) and high FGF23 (343 RU/dL). At that time his hemoglobin was 9.8 g/dL and his hematocrit was 29.5%. Both were started on Polyvisol with iron. At 14 months of life phosphorus and calcium were within normal limits, therefore calcitriol and phosphate were discontinued. At 15 months of age their hemoglobin, hematocrit, iron level, and TIBC levels were normal for both twins. Phosphorus was 4.6 and 4.3 mg/dL, alkaline phosphatase reduced significantly to 819 and 413IU/L, and FGF23 normalized to 100 RU/dL and 32 RU/dL on twin A and B respectively. Upon physical examination at 15 months of age, twin A was at the 0.02% for length and weight/length at the 31%; twin B was at the 5% for length and weight/length at the 50%. Both twins had high arched palates. Twin A had craniosynostosis, left renal agenesis, bilateral epicanthal folds, overlapping 2nd toes, and clinodactyly of the fifth digits. Note the donor kid (twin A) had a more severe presentation. Genetic testing showed heterozygous mutation c536G>a (p.Arg179GLN) in the FGF23 gene. This is the same mutation previously reported to be related with ADHR resolved with iron supplementation Conclusion The study of patients with hypophosphatemia and hypophosphaturia should include evaluation of iron status (ferritin, TIBC). Treating iron deficiency on these patients might normalize phosphate levels. This would avoid cumbersome treatment with phosphate and calcitriol. Laboratory values Phosphorus:4-8 mg/dL Alkaline Phosphatase: 130-317 IU/L FGF23: 44-215 RU/dL

Parenteral nutrition-associated cholestasis (PNAC) causes serious morbidity in the neonatal intensive care unit. Infection with gut-associated bacteria is associated with cholestasis, but the role of intestinal microbiota in PNAC is poorly understood. We examined the composition of stool microbiota from premature twins discordant for PNAC as a strategy to reduce confounding from variables associated with both microbiota and cholestasis. Eighty-four serial stool samples were included from 4 twin sets discordant for PNAC. Random Forests was utilized to determine genera most discriminatory in classifying samples from infants with and without PNAC. In infants with PNAC, we detected a significant increase in the relative abundance of Klebsiella, Veillonella, Enterobacter, and Enterococcus (P < 0.05). Bray-Curtis dissimilarities in infants with PNAC were significantly different (P < 0.05) from infants without PNAC. Our findings warrant further exploration in larger cohorts and experimental models of PNAC to determine if a microbiota signature predicts PNAC, as a basis for future interventions to mitigate liver injury.

Objectives The incidence of vertically transmitted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could be higher than published. We feel that cases of SARS-CoV-2 vertical transmission are under-reported. Case presentation We report a case of SARS-CoV-2 in premature monochorionic monoamniotic twins born by caesarean section to an asymptomatic SARS-CoV-2 positive mother. Conclusions This case supports the potential for intrauterine transmission of SARS-CoV-2 as previously reported. The incidence of SARS-CoV-2 vertical transmission from reported cases is low; however this may be due to the difficulty disproving horizontal transmission or under-reporting of cases.

There’s an undeniable warmth to Doris Taylor, Director of Regenerative Medicine Research and of the Center for Cell and Organ Biotechnology at the Texas Heart Institute and Texas A&M University in Houston. Professionally, she may be most famous for engineering the first bioartificial mammalian heart.1 But, on a personal level, her own heart is compassionate, generous, and not remotely artificial. Taylor went through great turmoil in early childhood, but rather than mentally closing herself off to pain and difficulty, she’s endeavored throughout life to ease the pain and suffering of others. In a recent interview with Circulation Research , she explained that she does this in two ways. At a community-level, she’s an ardent advocate for social justice, spending her spare time promoting local political organizations and spearheading worthy causes, while at the global-level, her scientific research adds to the body of medical knowledge that enables innovations, improves treatments, and saves lives. Doris Taylor Her research has certainly, and consistently, broken new ground. Her pioneering stem cell research, regenerative medicine strategies, and investigations of sex-specific physiological differences have driven new lines of enquiry in cardiovascular disease research and have also challenged established attitudes toward how such diseases might be treated.2–6 I was born in San Francisco and I had a twin brother. We were born very prematurely and, in those days, premature twins didn’t live, so neither of us were supposed to survive. My mother told us that the doctor came in and told her, if she was religious and believed in doing something for the end of life, she should do it for us. So, she called the hospital chaplain and he came, but then, according to my mother, the minute he left the room, my brother and I rallied. It was as if we’d …

Este estudo teve por objetivo descrever a assistência e caracterizar a evolução clínica de gemelares prematuros com risco de infecção congênita, nascidos de mãe infectada pelo SARS-CoV-2 e com quadro clínico de COVID-19. Trata-se de um relato de experiência descrito a partir de registros dos prontuários dos gemelares e de sua genitora. Gemelares prematuros, idade gestacional 28 semanas e três dias, ambos do sexo masculino. O gemelar I pesou 1050 gramas e o II, 698 gramas. Às 36h de vida foi realizada coleta por meio de swab de oro e nasofaringe, de ambos, para pesquisa de RT-PCR para SARS-CoV-2, positiva nos dois. O gemelar I faleceu com 48h de vida e o II ficou interno por mais de 2 meses na Unidade de Terapia Intensiva Neonatal. Não houve contato da genitora com os gemelares no momento do nascimento até o décimo quinto dia de vida do gemelar II, também não houve aleitamento materno nesse período. Nova pesquisa de RT-PCR para SARS-CoV-2 e teste rápido realizado no décimo quinto dia de vida foram negativos. É preocupante a possibilidade de transmissão de mãe para filho e as consequências que esse vírus pode causar no feto. Todavia, existem vários relatos que sugerem um baixo potencial dessa transmissão, no entanto essa possibilidade não pode ser descartada e deve estar assegurada por uma assistência adequada com equipe treinada e tomado todos os cuidados de transmissão após o nascimento.

To estimate whether antenatal corticosteroids before 34 weeks of gestation are associated with reduced incidence of respiratory distress syndrome (RDS) and composite neonatal morbidity in preterm twins.This was a secondary analysis of a multicenter randomized trial for the prevention of preterm birth in multiple gestations. All liveborn, nonanomalous twins delivered between 24 0/7 and 36 6/7 weeks of gestation were included. Neonatal outcomes were compared between women who received antenatal corticosteroids and those who did not. The primary outcome was the incidence of RDS. The secondary outcome was the incidence of serious composite neonatal morbidity. Multivariable log Poisson regression with correlation adjustment between twins born to the same mother was performed for confounder control. Adjusted relative risks (RRs) are reported for study outcomes. Based on a post hoc power analysis, this study was powered to detect an RR less than 0.63 for RDS and greater than 1.43 for composite neonatal morbidity outcomes.A total of 432 women (850 neonates) were included. Only 300 (35%) neonates were born to women receiving antenatal corticosteroids. After multivariable regression, antenatal corticosteroids were not associated with a reduced incidence of RDS (81 [27%] compared with 92 [17%] neonates, adjusted RR 1.28, 95% confidence interval [CI] 0.97-1.71) or composite neonatal morbidity (87 [29%] compared with 108 [20%] neonates, adjusted RR 1.21, 95% CI 0.93-1.56). However, antenatal corticosteroids were associated with increased rates of neonatal intensive care unit admissions (235 [78%] compared with 322 [59%] neonates, adjusted RR 1.22, 95% CI 1.09-1.36) and mechanical ventilation (70 [23%] compared with 66 [12%] neonates, adjusted RR 1.52, 95% CI 1.12-2.09). Focusing analysis to newborns delivered before 34 weeks of gestation (n=311), 161 (52%) received antenatal corticosteroids. Similarly, no differences in the rate of RDS (66 [41%] compared with 68 [45%] neonates, adjusted RR 1.01, 95% CI 0.76-1.34) or composite neonatal morbidity (72 [45%] compared with 81 [54%] neonates, adjusted RR 0.95, 95% CI 0.74-1.22) were noted.In this cohort of preterm twins, antenatal corticosteroid administration was not associated with a reduced incidence of RDS and composite neonatal morbidity.

Twin infants born at 34 week gestation had frank blood in stools on day three of life on mixed feeds of formula and maternal breast milk. Sepsis work up was negative in these relatively well appearing infants with pneumatosis in the colon on abdominal x-ray. Blood in stools recurred on reintroduction of breast milk in Twin A. Both infants recovered from episodes of bloody stools on amino-acid based formula and were thriving at discharge. Early necrotizing enterocolitis in both twins is rare and has not been reported. Cow's milk protein sensitivity, possibly from in-utero sensitization, could explain non-infectious colitis in these twins, precipitated by formula or breast milk after birth.

Background Sequence type 131 (EC-ST131) is a prevalent cause of extraintestinal Escherichia coli infection, including in neonates, and accounts for a majority of multidrug-resistant strains. Rare reports of neonatal unit outbreaks have emerged, with one linking the source to freshly expressed breast milk (BM) sharing. We report on premature twin girls whose infection was linked to their mother’s contaminated frozen BM. Methods Blood culture isolates were from twin girls born at 24–1/7 weeks’ gestation who developed severe sepsis caused by ampicillin- and gentamicin-resistant E. coli on days 11 (Baby A; died) and 8 (Baby B; survived) of life; both neonates had sterile blood cultures at birth, and received orogastric feeds using frozen BM provided by their mother. Five remaining frozen BM samples predating onset of sepsis were thawed and cultured; E. coli resistant to ampicillin and gentamicin was recovered from 1 collected on day 5 of life. DNA was extracted from cultured isolates using the Zymo Research Quick-DNA™ Fungal/Bacterial Miniprep kit, sequencing libraries prepared (Nextera® XT PE), and sequencing (Illumina MiSeq® with V2 2 X 250 bp chemistry) completed for the 2 blood and 1 BM isolates. Multilocus Sequence Typing (MLST) and core genome MLST (cgMLST) analyses were performed using SeqSphere+, version 5.1.0 (Ridom, Munster, DE) software, with 2513 alleles analyzed for cgMLST. Results The 2 blood and 1 BM isolates were typed as ST131 by MLST and were indistinguishable by cgMLST. Of the 2513 alleles queried, only 263 (10.5%) differed from the ST131 strain SCB34 (figure). Thus, our EC-ST131 cluster isolates belong to the same clonal complex as, but are genetically divergent from, SCB34. In addition to the E. coli described above isolated from a BM sample, all 5 frozen BM samples grew multiple morphotypes of coagulase-negative staphylococci. The mother had acute chorioamnionitis and was treated with intravenous ampicillin, gentamicin, and metronidazole for 48 hours immediately after delivery. Conclusion Despite frozen BM’s persistent antibacterial activity, it is a potential source of multidrug-resistant bacteria for neonates, as evidenced by this report of EC-ST131 neonatal sepsis in premature twins. Disclosures Robin Patel, MD, ASM and IDSA: Other Financial or Material Support, Travel reimbursement, editor’s stipends; CD Diagnostics, Merck, Hutchison Biofilm Medical Solutions, Accelerate Diagnostics, ContraFect, TenNor Therapeutics Limited, Shionogi: Grant/Research Support; Curetis, Specific Technologies, NextGen Diagnostics, PathoQuest, Qvella: Consultant; NBME, Up-to-Date, the Infectious Diseases Board Review Course: Honorarium recipient, Other Financial or Material Support; Patent on Bordetella pertussis/parapertussis PCR issued, a patent on a device/method for sonication with royalties paid by Samsung to Mayo Clinic, and a patent on an anti-biofilm substance issued: Other Financial or Material Support, Patents.

Although a leukemoid reaction is a well-recognized phenomenon in the neonatal intensive care unit, transient extreme hyperleukocytosis in premature infants is rare. The exact mechanism is still unclear and several hypotheses are documented in the literature. In this case report, we describe 2 dichorionic diamniotic premature twins, of whom the 2 girls had extreme hyperleukocytosis, whereas their siblings did not, emphasizing the potentially important role of the sex in this phenomena.

O objetivo deste estudo é relatar a experiência de um acompanhamento psicológico realizado a uma mãe de gêmeos prematuros por uma residente de psicologia no contexto hospitalar. Foram realizados 28 atendimentos individuais no ano de 2016, registrados em diário de campo e analisados segundo a abordagem winnicottiana e estudos sobre a psicologia hospitalar. Ao longo deste processo, os resultados indicam o crescimento psíquico e emocional da paciente, por meio de uma relação de escuta e compreensão, que permitiu a ressignificação da hospitalização dos filhos prematuros.

The usefulness of monozygotic (MZ) twins for studying the efficacy of different face lift techniques is described. The data suggest that no particular procedure out of four under consideration is superior to any other. Next, reviews of recent twin studies of congenital anomalies, personality traits and coital orgasmic infrequency, and physical activity participation are presented. Finally, timely topics of public interest are also described. They include a rare birth consequence of artificial reproductive technology, an update on state legislation regarding parents' rights to decide the classroom placement of their young twins, and medical malpractice lawsuits involving premature twins.

This paper describes the work with a family of premature twins in a neonatal intensive care unit (NICU), where one twin was born seriously ill and died within a few days. An overview of literature related to the birth of a sick premature baby, trauma and mourning with twins, and the impact of loss on the surviving twin, forms the first section. Informed by psychoanalytic theory, the author explores the painful work with the parents through detailed observation, noting particularly the difference between the father's capacity to stay in touch with the pain of loss and mother's denial and preoccupation with the healthy twin.

We attempted to identify the association of multifocal hemangiomas, specifically hepatic hemangiomatosis, in twins. We retrospectively reviewed our database of infants with hemangiomas, identifying those twins who both had hemangiomas, and we report two cases of twins with hemangiomatosis, including hepatic hemangiomas. Of 39 sets of twins in our Hemangioma Program, both twins had hemangiomas in seven twin sets. Of these seven sets, only the two reported in this article had hemangiomatosis. There were also five sets of triplets, with one set having two siblings affected by hemangiomas. We concluded that although hemangiomas in multiple gestation infants is well known, hemangiomatosis including hepatic hemangiomatosis is unusual.

UNLABELLED This study investigated the supply of the essential trace element molybdenum (Mo) in infants with preternatural anus. It was divided into two separate investigations: (A) the complete fecal excretion of nine patients was collected in fractions over 24 h; and (B) 72 h balance studies and parallel plasma analysis were conducted in five infants and complemented by the longitudinal comparison of one of these patients with his (otherwise healthy) premature sister. Atomic absorption spectroscopy (balance studies) and high-resolution inductively coupled plasma mass spectrometry (HR-ICP-MS, plasma) were used for analysis. The following results were obtained. (A) The fecal Mo concentration ranged from 1.98 to 42.02 nmol Mo g(-1) dry fecal weight. (B) The daily intake in the balance studies was 43.2 (11.33-100.5) nmol Mo kg(-1) and the median retention was -2.91 (-32.45 to 48.6) nmol Mo kg(-1). In the premature twins the boy with an intestinal stoma had a negative balance and lost -3.32 micromol within 32 d, while his sister retained +0.45 micromol Mo in the same period. Plasma Mo ranged between 9.4 and 46.7 nmol l(-1). CONCLUSION The negative Mo balance results may indicate an increased risk of Mo deficiency in infants requiring a long-term preternatural anus.

Kangaroo Care has been shown to keep a singleton preterm infant warm by body heat generated in maternal breasts that is conducted to the infant. No studies have examined whether twins simultaneously receiving Kangaroo Care, called Shared Kangaroo Care, are sufficiently warm and how the breasts respond to twin presence. Two case studies were done to determine the temperatures of twins being simultaneously kangarooed and the temperatures of maternal breasts during Shared Kangaroo Care. Two sets of premature twins were held in Shared Kangaroo Care for 1.5 hours. Infant temperatures were recorded from incubators; breast temperatures were recorded from thermistors. Infant temperatures remained warm and increased during Kangaroo Care, and each breast appeared to respond to the thermal needs of the infant on that breast. Physiological explanations for thermal synchrony exist. These data suggest that twins can be simultaneously held in Kangaroo Care without thermal compromise because each breast responds individually to the infant's thermal needs. JOGNN , 35, 223‐231; 2006. DOI: 10.1111/J.1552‐6909.2006.00024.x

There are numerous known or unknown maternal, fetal and intrauterine conditions that may lead to growth restriction. In addition to prematurity and growth restriction, developmental outcome may also be influenced by many genetic and environmental factors.To examine the impact of intrauterine growth restriction on development in premature discordant twins.Intra-pair control comparison.Developmental outcome at age 3 years was examined in 21 pairs of discordant (15% birth weight discordance) very low birth weight (VLBW) premature twins.None of the smaller twins had cerebral palsy and one larger twin had a mild diplegia. In paired comparisons, the smaller twins were somatically smaller and had a slight lower Griffiths' developmental quotient (GQ) than the co-twins without cerebral palsy [mean+/-S.D. 100+/-13, range 73-117, versus 104+/-12, 80-124, p=0.002]. The largest difference was in the locomotor subscale. There was a greater intra-pair GQ difference in the 12 twin pairs who had a discordance of greater than 30% (mean GQ=98 versus 105, p0.001). The intra-pair GQ correlated well (r=0.90), a finding similar to that of a comparative group of 26 nondiscordant VLBW twin pairs (r=0.87). A multivariate analysis confirmed that gestation and percentage discordance were the important factors influencing GQ.There exists a strong influence of common intrauterine, genetic and environmental factors on developmental outcome. Despite an overall lack of adverse outcome in smaller twins, results indicated a small but significant influence of growth restriction.

To report the use of near-infrared spectroscopic monitoring to recognize mesenteric oxygen desaturations in a preterm neonate with necrotizing enterocolitis as well as the demonstration of reassuring mesenteric tissue perfusion in a twin sibling with an uncomplicated course.Case report.Neonatal intensive care unit in a tertiary care children's hospital.A 12-day-old growth-restricted preterm female twin with necrotizing enterocolitis and her twin who did not develop disease.In the twin with symptoms of necrotizing enterocolitis, reduction in the mesenteric saturations was recorded in the injured bowel tissue as later confirmed during surgery. After resection of the ischemic bowel, mesenteric saturations returned to values comparable to those measured in the healthy twin. Reduced saturations were not observed in the asymptomatic twin.The use of optical oximetry to monitor mesenteric tissue saturation may provide a measure of bowel perfusion that could enhance clinical management in at-risk preterm neonates.

Acute retinal necrosis, caused by the herpes family of viruses, is a rapidly progressing ocular inflammatory disorder commonly reported in adults but rarely in children. The accepted diagnostic criteria include presence of 1 or more foci of retinal necrosis, rapid progression, circumferential spread, occlusive vasculopathy, and inflammation in the vitreous and anterior chamber. We report bilateral acute retinal necrosis with encephalitis due to herpes simplex virus (HSV-2) in newborn twins.

The delivery of twins presents considerable challenges to the obstetric team, particularly in terms of decision-making, technical skills required and the need to respond quickly to changing circumstances. There is a serious lack of sound evidence upon which to base decisions concerning the method of delivery of twins. The trend towards the routine use of caesarean section is not supported by evidence of improved outcome for the infants, while maternal outcome is compromised. Specific circumstances that may have a bearing on the need for caesarean section include gestational age, presentation of the twins and chorionicity/amnionicity. Caesarean section does not eliminate the chance of fetal trauma during delivery, particularly for premature twins. The techniques of twin delivery, whether vaginal or by caesarean section, require thorough preparation for all possible eventualities, and skilled teamwork. Particular attention should be paid to emotional needs during labour, birth and afterwards, of the parents of twins.

This paper presents observations of boy and girl twins on a neonatal intensive care unit, following them through from 10 days old to return home. The observer hypothesizes about the experience of the twins as they progress, based on detailed notes of their actions. The preoccupations of the parents are incorporated, as are reactions and interventions of staff. The place and possible functions of such observation by a child psychotherapist attached to such a unit are elaborated in the concluding section.

Premature newborns and infants are usually required to successfully transition from gavage to nipple feeding using breast or bottle before discharge from the hospital. This transition is frequently the last discharge skill attained. Delayed acquisition of this skill may substantially prolong hospital length of stay. The authors describe a case of hospitalized premature twins who had considerable delays in attaining nipple-feeding skills. Because of their inability to take all feedings by nipple, preparation for surgical placement of gastrostomy tubes was initiated. Before the surgeries were scheduled, the inpatient osteopathic manipulative medicine service was consulted, and the twins received a series of evaluations and osteopathic manipulative treatment (OMT) sessions. During the OMT course, the twins' nipple feeding skills progressed to full oral feeding, which allowed them to be discharged to home without placement of gastrostomy tubes. The authors also review the literature and discuss the development of nipple feeding in premature newborns and infants and the use of OMT in the management of nipple feeding dysfunction.

Risk factors associated with prematurity and adolescent parenting greatly increase when combined with multiple birth. Kangaroo care (KC) for preterm infants is well documented, although KC with twins or with adolescent parents is mentioned only briefly. In this case study, adolescent parents experience KC with their 32-week twin sons beginning 19 hours postbirth. These young parents interacted with, responded to, and took responsibility for their newborn sons, behaviors that are sometimes difficult for adolescent parents. Thus, KC appeared to be an effective intervention for these adolescent parents. Additionally, three kinds of KC with twins were identified: separate, sequential, and shared.

A case of disseminated candidosis in a premature newborn twin I (26th weeks of pregnancy) is reported. A severe mycotic infection of the organs, especially the kidneys was present. Even Candida in the pancreatic islets of Langerhans cells could be demonstrated. Twin II also suffered a Candida infection but in contrast to twin I she survived after therapy. Candida infection of twins is rarely reported in the literature.

A unique case of disseminated candidosis in premature twins is presented where twin A developed disease soon after birth and died prior to the administration of antifungal therapy. On the other hand, twin B developed infection on the 26th day of birth but survived, though with sequelae (hydrocephalus), since he was promptly and accurately diagnosed and treated.

To determine that slower weight premature twins have more risk to develop severe retinopathy of prematurity (ROP) than the higher weight twins. We know that the lower weight twins had less optimal intra-uterine environments than their higher weight twins. We screened 94 consecutive premature twins for ROP. We compared the lower weight twins (n = 47) against their higher weight twins (n = 47). The risk of severe ROP (ROP stage 3 or greater) was significantly higher in the lower weight twin group (p 0.006). In the same way, in the lower weight twin group the non-perfused area of the temporal retinal artery was higher than that of the other group (an average of 1.2 diameters of the optic nerve head), in the 4-6 postnatal weeks (p 0.004). The lower weight twin group have an increased risk of severe ROP associated with bacteremia (p = 0.045), or a weight gain less than 7 g per day in the 4-6 postnatal weeks (p = 0.013) or a supplementary postnatal oxygen4 days (p = 0.007) compared to the higher weight twin group. We confirm Dr. Lee's work that less optimal prenatal factors, in preterm twins, increase the risk of severe ROP.

Pyloric stenosis is a common infantile disorder typically occurring between 2 weeks and 8 weeks of age. Presentation outside this range and in premature infants is uncommon and often atypical. We present three cases, a pair of premature twins and a 5.5-month-old infant with pyloric stenosis. We highlight that despite their difference in size and weight, ultrasound examination remains a reliable diagnostic tool. However, pyloric measurements should be interpreted in combination with the other dynamic features on ultrasound.

Thyroid dysfunction is recognized in the newborns of mothers affected by Graves' disease during pregnancy. We describe the development of concurrent hyperthyroidism and hypothyroidism in the twin infants of a mother with Graves' disease diagnosed during pregnancy.

Three pairs of premature twins ranging in age from 2 to 4 days were managed for idiopathic gastrointestinal perforation from July 1989 to December 1990. All were boys who were born prematurely and were being treated in a neonatal intensive care unit when the perforations were diagnosed. The sites of perforation were identical in each pair of twins, and the occurrence of perforation in one preceded the other. Three of the six infants died (50%) in the postoperative period. This observation should alert the clinician to the possibility of a bowel perforation in a second twin when it occurs in the first.

Background: Evidence suggests that twins are disadvantaged in terms of long-term growth and neuro-developmental status. This may in part be due to the increased risk of prematurity that twins face, in particular late prematurity. Aim: We investigated neuro-developmental outcomes of a cohort of 40 pairs of late premature twins (32+ 0 to 36+ 6) at 2-3 years of age through a standardised developmental questionnaire, The Ages and Stages Questionnaire, 3rd edition. (ASQ) This group of children were compared to a control group of 40 pairs of term twins of similar age. Methods: The Ages and Stages questionnaire is a developmental assessment questionnaire which looks at 5 areas of development. Twins were recruited from 4 centres across Ireland. Parents were contacted via telephone. The ASQ was sent out to each twin pair between 2-3 years of age. Results: Both groups had mean scores in the normal range for all areas of development. The late pre-term group however, had statistically significant lower scores in the areas of communication, (mean 52.7 +/− 12.55 vs 58.6 +/−, p value less than 0.001), problem solving (mean 51.4 +/− 11.45 vs 57.7 +/− 3.89, p value less than 0.001) and fine motor (mean 43.6 +/− 10.94 vs 48.4 +/− 10.7, p value 0.01.) Conclusion: Tools such as the ASQ are able to detect significant differences in development between late pre-term twins and term twins. The ASQ tool may be a cost effective means of surveying large populations of late pre-term infants who would not otherwise have developmental surveillance.

During a screening protocol of early echocardiographic diagnosis (ATL MK 600) and treatment of “silent” PDA in RDS preterms with BW ≤ 1.750 kg, clinical data on premature twins were collected, including diagnosis of both PDA and BPD, to investigate whether twin birth influences PDA incidence and BPD development. Out of the 290 RDS preterms evaluated, 96 (33%) showed evidence of PDA, and a total of 79 (27%) developed BPD, 47 (16%) with associated PDA and 32 (11%) without PDA. Out of 238 singletons, 74 (31%) presented “silent” PDA and a total of 75 (31%) developed BPD, 44 (18%) with associated PDA, and 31 (13%) without PDA. In 52 other twins (18% of the total number of babies studied), 22 (42% of this subgroup) presented evidence of “silent” PDA, and 4 (8% of the subgroup), developed BPD, 3 with associated PDA (6% of the subgroup), and 1 without PDA (2% of the subgroup). From these data, it is inferred that that low-birthweight twins are at high risk for PDA hemodynamic complications during RDS, and may benefit from early induced ductal closure. Instead, in RDS twins, BPD was statistically less frequent (at the 99% C.L.) probably because twinning enhances fetal lung maturity, influencing enzymatic and nonenzymatic protective systems of lung defence.

Jejunal atresia with “apple peel” deformity is a rare congenital malformation that is generally believed to result from in utero vascular accidents. We report this case due to the rare occurrence of jejunal atresia with “apple peel” deformity affecting both members of a set of twins in whom no apparent cause for the atresia exists.

This paper describes methods of measuring a preference a mother develops for one twin over the other and describes the effect such preference has on the intellectual functioning and behavior of 24 twin pairs over 4 years. Results indicate that the majority of mothers develops a preference for one premature twin within 2 weeks after birth and maintains this preference for at least 4 years. The preferred twin has fewer behavior problems and a higher 1Q at age 4. However, temperament is not correlated with preferential status. J. Am. Acad. Chil Adolesc. Psychiatry , 1990, 29, 3:367–374.

Editor—Randomised, placebo controlled trials of antenatal corticosteroid administration have not shown a significant reduction in the incidence of respiratory distress syndrome (RDS) in premature twins.1 Subsequent retrospective studies examining the effect of steroids on twin pregnancies have shown conflicting results.2 3 Further to our recent article,4 we have investigated the relation between respiratory distress and antenatal corticosteroid treatment in premature twins from the same historical cohort selected …

A retrospective study from January 1, 1976, through July 31, 1981, was performed to evaluate the relationship between type of delivery and perinatal morbidity and mortality in twins of birth weight less than 2,000 gm. Vaginally delivered second twins who weighed 601 to 999 gm had increased risk of neonatal mortality when compared to their siblings. Among twins who weighed 1,000 to 1,499 gm, vaginally delivered second twins had significantly lower Apgar scores and inceased risks of neonatal morbidity in comparison to their siblings, whereas second twins who were delivered by cesarean section had no difference in Apgar score or neonatal morbidity from those of their siblings. In twins who weighed 1,500 to 1,999 gm. a significant increase in neonatal complications in vaginally delivered second twins was not found, although the majority of neonatal complications did occur in vaginally delivered second twins. Cesarean section is proposed as the optimal route of delivery for all twins expected to have a birth weight less than 1,500 gm.

This study examines 20 pairs of twins with a birthweight of less than 1500 g and their parents during weekly parental nursery visits and during home feedings at 6 weeks, 3 months, and 6 months after the twins' expected date of birth. All infants were rated daily on 19 operationally defined medical complications. During each of these visits various maternal and infant behaviors were recorded and the preference of the mother toward either twin assessed. Results indicate that mothers generally develop a clear preference for one twin within 3 weeks after birth, and that the preferred twin almost invariably is the healthier one. In addition, the preferred twin at 3 and 6 months shows significantly more social behaviors than the nonpreferred twin.

In follow-up psychological examinations of two groups of premature same-sex twins in preschool and school age (18 pairs with dissimilar and 15 pairs with similar birth weight), intelligence, visual and auditory perception, and drive, were evaluated.The twins with lower birth weight usually attained lower IQs than their cotwins with higher birth weight, and nearly as a rule had poorer IQs of Verbal and Performance Scales. They also more often were hyperactive and had concentration difficulties. There were no differences in visual and auditory perception.

Summary To our knowledge, this is the first reported case of esophageal atresia occurring in both members of a pair of twins. These twins appear to be genetically identical because of their general appearance, sex, identical anomaly, and identical serologic genotypes. Genetic predisposition for esophageal atresia in twins would seem to be possible from this study. Heretofore, it has been thought that esophageal atresia in one of identical twins has been a developmental defect rather than a genetically transmitted one. Staged therapy for the premature infant with esophageal atresia increases the chance of survival of these infants.