Second-born Twins Research Articles

The epidemiology of sudden infant death in upstate New York: II: birth characteristics.

This study describes the epidemiology of sudden infant death syndrome (SIDS) among infants born during 1974 to upstate New York residents. Birth certificate characteristics for 184 SIDS cases are compared with those of 417 infants dying from other causes in the same age range, 7-365 days. The results confirm the following as infant risk factors: fall or winter birth, low birthweight for gestational age, twin birth, and live birth order three or more. Maternal risk factors include: age under 20, abnormal uterine bleeding during pregnancy, late initiation of prenatal care, less than 12 years of education and single marital status. The increased risk for mothers who first gave birth in their teens and for second-born twins has not been previously reported. The evidence that SIDS babies are small for gestational age, that twins, especially the second born, and babies whose mothers experienced abnormal uterine bleeding during pregnancy are all at increased risk of SIDS suggests that perinatal stress leading to hypoxia is one of the components that determine the risk of SIDS.

Lecithin/sphingomyelin ratio in twins

SummaryNewborn babies who develop the respiratory distress syndrome (RDS) have reduced amounts of lung surfactant, shown by a low lecithin/sphingomyelin (L/S) ratio. Twins, especially second-born twins, are more likely to suffer from RDS than singleton babies.Surfactant was investigated in the pharyngeal aspirates at birth of 36 twin pairs and the results were compared with those of 121 singletons. Twins had significantly lower pharyngeal L/S ratios than singletons, when born between 29 and 35 weeks maturity and between 38 and 40 weeks, but not when born between 36 and 37 weeks.There were no significant differences between the L/S ratios of first and second-born twins, but there was a highly significant correlation between them (r = 0·56; P < 0·001).

Neonatal Type 2 Herpes simplex Encephalitis in an Identical Twin

A case of type 2 neonatal herpes simplex encephalitis is presented. The mechanism of infection is discussed in view of the fact that the firstborn identical twin was unaffected. Longer exposure to the virus during delivery is proposed as an explanation for the involvement of only the secondborn twin.

Behaviour of the ewe and lamb at lambing and its relationship to lamb mortality

A number of behavioural traits associated with the maternal instinct of sheep were studied under paddock conditions over a range of breeds, age, climate, nutrition and locations in five lambings in south Western and north Western Australia. There was very considerable variation between ewes in any group in the occurrence and timing of each trait. There were few differences due to breed, age of ewe, nutrition, climate or location in the behaviour of the ewe before and during parturition. Nearly all the differences that occurred were in the frequency of pawing the ground before and during labour. Fewer Southdowns and Merinos pawed the ground than ewes of other breeds. Also this trait occurred more in summer than in winter in south Western Australia, and less here than in north Western Australia. The behaviour of the ewe during the post partum period was highly predictable. She normally stood and commenced cleaning within 1 min of birth. Cleaning commenced at the head and progressed down the body. Desertions and other forms of aberrant behaviour were uncommon. There were no biologically significant differences in length of labour, time from birth to stand and time from stand to first drink due to breed, age, pre-lambing nutrition, climatic conditions or location. Second-born twins were delivered after a significantly shorter labour than first-born twins. In one series of observations twins took longer to drink than singles. Type of birth did not influence the time taken for the lamb to stand. Rectal temperature three hours after birth dropped significantly when rainfall exceeded 2 mm during the 3 h. Lamb mortality increased significantly in wet weather in winter and most lambs which died more than 3 h after birth had a depressed rectal temperature at 3 h. The ewes of lambs which died after standing tended to have longer than average labour. Poor maternal behaviour per se was the cause of 16% of lamb deaths and failure of the lamb to drink after standing caused 23% of lamb deaths in winter in south Western Australia. In summer in both environments heat stress was the primary cause of lamb deaths.

Discordance for childhood coeliac disease in monozygotic twins.

Discordance for childhood coeliac disease in monozygotic twin boys is reported. The diagnosis of coeliac disease in the second-born twin was established by demonstration of a flat small intestinal mucosa on biopsy and a clinical response to a gluten-free diet. The first-born twin had a normal small intestinal mucosa. Phenotypic, genotypic, and dermatoglyphic observations as well as gross observation of the placenta and membranes provided strong evidence that these twin boys were monozygotic.

Gangrene of an Extremity in the Newborn

A second-born twin with intra-utenine gangrene of the right lower limb secondary to a dissecting intramural hematoma of the femoral artery is reported. Although trauma seems most likely, the exact mechanism of intramural hemorrhage with compression and obliteration of the lumen of the vessel remains unknown.

Clinical consideration of occlusion: A serial study

1. 1. In a group of eighteen children with good occlusion at the time of the completed permanent dentition, including the second molars, there were sixteen cases of good occlusion in the corresponding deciduous dentition. 2. 2. In a group of twenty children with poor occlusion in their completed permanent dentition, nine had Class I and eleven had Class II malocclusions. In the corresponding deciduous dentition, six had Class I, nine Class II, and five had good occlusion. These figures indicate that in many cases occlusion is established early in life. 3. 3. In a pair of identical twins, although the first-born had the advantages in weight, height, method of early feeding, and bone development, the second-born twin had the better occlusion. 4. 4. In the deciduous dentition from 2 1 2 years to 5 1 2 years, the increase in interdental spaces can rarely be seen or measured; yet, measurable changes are reflected in the dental arches. 5. 5. In two cases of excellent occlusion development from birth to 17 years, neither prolonged bottle feeding nor thumb-sucking impaired the occlusion. 6. 6. In two cases of good occlusal development from birth to 17 years, there is a suggestion that the slight vertical overbite may have resulted from colds, enlarged and infected tonsils and adenoids, or spacing between the teeth. 7. 7. In three cases of poor occlusal development from birth to 17 years, there are multiple factors operating. Thumb-sucking was an accentuating factor of the existing poor occlusion in one case. Loss of teeth was the main factor in changing a good occlusion to a poor one in one case. 8. 8. In the six successfully treated cases presented, the dental arches were expanded, lengthened, or shortened, and overbites were corrected. 9. 9. A simple system of spatial measurements has been suggested for objective evaluation of our casts.

AORTIC ATRESIA WITH HYPOPLASIA OF THE LEFT VENTRICLE

In a series of 1,000 cases of congenital heart disease Abbott1included 12 cases in which aortic atresia was the primary lesion and 2 additional cases in which it was associated with another cardiac defect. In 1 of these cases a systolic murmur was noted, in 1 a continuous murmur and in 8 cyanosis. Roberts2found 9 cases of this anomaly alone and 6 additional cases in which it was associated with other congenital cardiac defects. He reported another case, that of a second-born twin who had severe cyanosis and dyspnea and who died twenty hours after birth; the first-born twin, who died immediately after birth, had a normal heart. In this group of cases Roberts correlated the duration of life with the size of the interatrial aperture. Three of the same cases were included in a review by Lippincott,3who added the report of a case

Changes in the protein partition of serum during allergic episodes: Aubry, Thiodet, and Ribiere: Compt. rend. Soc. de biol. 123: 327, 1936

The objective of the study was to determine the clinical significance of amniotic fluid (AF) sludge in twin pregnancies with a short cervix.We evaluated twin pregnancies with a short cervical length that had an ultrasound between 16 and 26 weeks (n = 78). Pregnancy outcomes in those with sludge (n = 27) and those without (n = 51) were compared. Outcome variables included gestational age at delivery, premature rupture of the membranes, chorioamnionitis, funisitis, composite neonatal morbidity, and perinatal death. For statistical analysis, the first-born (A) and second-born (B) twins were studied separately.The prevalence of AF sludge was 34.6% (27 of 78). Pregnancies with sludge delivered earlier (27.2 ± 5.6 weeks vs 31.0 ± 4.05 weeks, P < .01) and had a higher rate of extreme prematurity (<26 weeks: 52.2% [12 of 23] vs 15.6% [5 of 32]; P < .01). Both twins had higher rates of histological chorioamnionitis (twin A, 50.0% [13 of 26] vs 12.8% [6 of 47]; P < .01; twin B, 42.3% [11 of 26] vs 13.3% [6 of 45]; P < .01) and neonatal death (twin A, 33.3% [9 of 27] vs 3.9% [2 of 51]; P < .01; twin B, 33.3% [9 of 27] vs 6.0% [3 of 50]; P = .01). Higher rates of funisitis (23.1% [6 of 26] vs 4.3% [2 of 47]; P = .02) and composite neonatal morbidity were observed for twin A only (66.7% [14 of 21] vs 37.5% [18 of 48]; P = .04).The presence of AF sludge in twin pregnancies with a short cervix is a risk factor for extreme prematurity, histological chorioamnionitis, and perinatal death. Twin A had higher rates of funisitis and neonatal morbidity in the presence of AF sludge.