Abstract
Introduction: Countries with limited resources have real difficulties in separating craniopagus twins. Separation surgery cannot be considered there due to lack of technological conditions and appropriate means. Objective: To show the benefits of an Italian-Central African humanitarian collaboration, after two years follow-up, aiming to improve the first childhood years of craniopagus twins, born in the Central African Republic and separated in Rome. Case Report: The two female conjoined craniopagus twin, born at term on June 29, 2018 in Mbata located about 96 km from Bangui (CAR), were referred to the neonatology unit of the CHUPB on their 3rd day of life. The mother was 31-year-old, gravida 4 and para 5. Prenatal cares were quantitatively and qualitatively poorly followed. The diagnosis of posterior conjoined craniopagus twins associated with early neonatal infection was retained. After seven days of antibiotics and regression of infectious symptoms, the newborns were kept in the neonatology unit for a closer follow-up, pending the completion of administrative procedures for a medical evacuation as part of the international humanitarian activities of the Pediatric Hospital of the Holy Seat in collaboration with the Pediatric Teaching Hospital in Bangui. Finally, the twins were transferred to the Bambino Gesu Hospital in Rome on September 10, 2018 where the 3D images confirmed the total posterior fusion. Between May 2019 and June 2020 thirty hours of interventions allowed a step-by-step separation of the twins, with a gradual rerouting of the shared blood supply, remodeling and re-creating a skin to cover the skull bones. No postoperative complications were recorded; the twins recovered satisfactorily after 6 months of separation and are awaiting discharge at their origin country where the CHUPB team will continue monitoring. Conclusion: The successful separation of total posterior craniopagus twins remains historically scarce and the guarantee of success has been based on detailed and well planned surgical management.
Highlights
Countries with limited resources have real difficulties in separating craniopagus twins
After seven days of antibiotics and regression of infectious symptoms, the newborns were kept in the neonatology unit for a closer follow-up, pending the completion of administrative procedures for a medical evacuation as part of the international humanitarian activities of the Pediatric Hospital of the Holy Seat in collaboration with the Pediatric Teaching Hospital in Bangui
In countries such as Central African Republic, surprise often occurs during childbirth; as prenatal diagnosis is not done with the use of relatively low health services and often qualitatively poor follow-up
Summary
In countries such as Central African Republic, surprise often occurs during childbirth; as prenatal diagnosis is not done with the use of relatively low health services and often qualitatively poor follow-up This reality reveals the problem of the practitioner’s anxiety the developing countries face to the lack of solutions and the resignation of the patient’s surrounding abandoned to their sad fate, while the solution exists in developed countries. In this specific case, exchanges based on a fair ethical consideration made it possible to push back the limits of this problem and to overcome the inequality of opportunities mentioned in the first 1000 days after birth. The current report, focusing on abnormalities in infantile period which may affect in the long term the development of the future adult, aims to describe the interventions preceding the correction of the abnormalities and to show the type of collaboration likely to remove the financial barriers preventing the access to quality care in developing countries
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