Twin Infants Research Articles

Unilateral primary pulmonary agenesis and hypoplasia in monozygotic twins

We describe 10-month-old identical female twin infants, one with primary left-sided pulmonary agenesis and the other with primary left-sided pulmonary hypoplasia. They came to our outpatient clinic complaining of persistent dry cough. The clinical examination revealed decreased air entry over the left hemithorax. Chest x-rays showed complete left-sided radio-opacity in both the twins. The chest computed tomography scan with contrast confirmed the diagnoses of left-sided pulmonary agenesis (twin A) and left-sided hypoplasia (twin B). No other associated congenital anomaly was noted in either of the twins. To our knowledge, such a condition in live monozygotic twins has not been previously reported in published studies.

Irritant Contact Dermatitis Due to Ammonium Bifluoride in Two Infant Twins

Ammonium bifluoride is one of the most corrosive acids that may produce severe chemical burns when in contact with skin. This hazardous chemical is widely used in household products. We report two pediatric cases of irritant contact dermatitis after exposure to a rust remover, which contained ammonium bifluoride.

Elective single embryo transfer and perinatal outcomes: a systematic review and meta-analysis

To determine whether elective single embryo transfer (eSET) lowers the risk of poor perinatal outcomes associated with IVF, when [1] compared with double embryo transfer (DET) or multiple embryo transfer (MET), and separately, [2] compared with spontaneous conceptions. Systematic review and meta-analysis. Centers for reproductive care. Infertility patients. MEDLINE, Embase, and bibliographies were searched for the period 1978-2011. Two reviewers independently assessed titles, abstracts, and full studies, extracted data, and assessed quality. Dichotomous data were pooled using relative risks and continuous data with mean differences using a random effects model. Randomized controlled trials (RCTs), case-control studies, and cohort studies that examined any of the primary or secondary outcomes in singleton, twin, or multiple-order infants conceived by eSET as compared with [1] those conceived by DET or MET or [2] spontaneously conceived singleton gestations were included. Primary outcomes were preterm birth (PTB, <37 weeks' gestation) and low birth weight (LBW, <2,500 g). Sixteen studies were included (eight RCTs, eight cohort studies). Compared with DET-conceived infants, eSET-conceived singletons were less likely to be born either preterm (RCT-based relative risk [RR] 0.37, 95% confidence interval [CI] 0.25-0.55) or with LBW (RCT-based RR 0.25, 95% CI 0.15-0.45; cohort study RR 0.51, 95% CI 0.29-0.91). However, compared with spontaneously conceived singletons, eSET gestations had higher risks of PTB (RR 2.13, 95% CI 1.26-3.61), placenta previa (RR 6.02, 95% CI 2.79-13.01), gestational diabetes (RR 1.69, 95% CI 1.19-2.42), and ectopic pregnancy (RR 6.40, 95% CI 4.38-9.35). Elective single embryo transfer is associated with decreased risks of PTB and LBW compared with DET but higher risks of PTB compared with spontaneously conceived singletons.

Changing Spectrum of Retinopathy of Prematurity (ROP) and Variations Among Siblings of Multiple Gestation

To assess the changing spectrum of ROP, and to compare the siblings of multiple gestations with regard to incidence and severity of ROP. A prospective study was done among a total of 158 infants (including 19 twin pairs), selected for ROP screening as per American Academy of Pediatrics (AAP) criteria. Data collected was analysed to assess the changing ROP spectrum in comparison to year 2002 ROP screening data from the authors' centre, and the variations among siblings of multiple gestation. Overall incidence of ROP was about 45.57% in 2009 as compared to 44.60% in 2002. 17 risk factors were found significantly associated with ROP on univariate analysis with low gestational age, low birth weight and multiple gestation (not analyzed in the 2002 data) confirmed as independent risk factors for ROP .The absolute number of subjects with severe ROP (>stage III) has decreased at the authors' centre. Twins with ROP were sicker as compared to the other sibling. Though overall incidence of ROP has remained the same over the last decade at the authors' centre, absolute number of severe forms of ROP has decreased. Multiple gestations may be taken as an independent risk factor for ROP causation. Sicker the twin infant is, the more are the chances that he/she will develop ROP.

Tel Hashomer camptodactyly syndrome in identical twin infants

Tel Hashomer camptodactyly syndrome in identical twin infants

Birthweight of full-term twin infants in relation to sex-pair

The present study examined the effect of sex-pair on birthweight of twins. The birthweight and sex-pairs of 104 live-born full-term twin pairs were recorded and analyzed. The mean birthweight and the mean birthweight sum of a different-sex twin pair were compared with that of a same-sex twin pair. The relative incidence of low birthweight (LBW) and birthweight discordance in the different-sex twin pair and same-sex twin pair were examined. Comparing the mean birthweight of the different-sex twin pair with that of same-sex twin pair, it was 2503 ± 428 g [95% confidence interval (CI) = 2369–2637] versus 2398 ± 442 g (95% CI = 2291–2505), p > 0.05. The overall mean birthweight sum of the different-sex twin pair was 3889 ± 492 g (95% CI = 3679–4099) while, for the same-sex twin pair, it was 3665 ± 512 g (CI = 3493–3837), p > 0.05. The mean birthweight sum for the male-male twin pair was 3903 ± 536 g (95% CI = 3648–4158), while for the female-female twin pair it was 3426 ± 560 g (95% CI = 3160–3192); p < 0.05. The mean birthweight of female infants in the male-female twin pair was 2081 ± 492 g (95% CI = 1927–2235) compared with 1795 ± 502 g (95% CI = 1635–1955) for female infants in the female-female twin pair; p > 0.05. The figures for the male infants in the male-female pair and the male-male twin pair were 2136 ± 468 g (95% CI = 1989–2283) and 1976 ± 519 g (95% CI = 1804–2148), respectively; p > 0.05. Rate of delivery of LBW twin pairs in all live-born twins were: different-sex, 51.3%; male same-sex, 43.8%; and female same-sex, 75.8%. Of the 59 LBW twin pairs, 20 (33.9%) were different-sex and 39 (66.1%) were same-sex twin pairs. In conclusion, cohabitation in the uterus of twin fetuses of different sexes influenced their intrauterine growth.

The Changing Epidemiology of Preterm Twins and Triplets Admitted to Neonatal Intensive Care Units in Canada, 2003 to 2008

We describe trends in the rates of admission of preterm twin and triplet infants to neonatal intensive care units (NICUs) across Canada and compare their neonatal outcomes over a 6-year period. Temporal trends of admission rates for 5193 twins and triplets < 33 weeks' gestational age to participating NICUs in the Canadian Neonatal Network between 2003 and 2008 were assessed. Trends in infant outcomes were evaluated using logistic regression. The proportion of twins increased from 26.1 to 28.0 per 100 admissions between 2003 and 2008 (7% increase, p = 0.02). In contrast, the proportion of triplets decreased from 5.0 to 3.3 per 100 admissions (34% reduction, p = 0.04). These trends were significant in mothers ≥ 35 years of age. Neonatal outcomes improved for preterm twins (mortality, p < 0.01; survival without any major morbidity, p < 0.01; severe neurological injury, p = 0.02; and severe retinopathy of prematurity, p = 0.03). Similar improvements were observed for triplets, but the sample size was insufficient to reach statistical significance. The rate of NICU admissions for preterm twins at < 33 weeks' gestation has increased in recent years, whereas for triplets it has gradually declined. Neonatal outcomes of preterm twins improved over the study period.

Birth outcomes of intended pregnancies among women who used assisted reproductive technology, ovulation stimulation, or no treatment

To study birth outcomes among live born infants conceived by women who used infertility treatment. Population-based surveillance of women who recently delivered a live infant. The birth outcomes among infants whose mothers used assisted reproductive technology (ART) or ovulation stimulation medications alone were compared with the outcomes of infants conceived without treatment. Stratified random sample of women who were attempting conception and gave birth to a live infant in six US states (n = 16,748). Assisted reproductive technology and ovulation stimulation. Adjusted odds ratios for perinatal outcomes. The prevalence of infertility treatment use overall among women attempting conception was 10.9% (5.4% ART procedures, 5.5% ovulation stimulation medications). Singletons of mothers who received ART procedures were more likely to be born with low birthweight, preterm, and small for gestational age (SGA) than singleton infants conceived without treatment. Singleton infants of mothers who used ovulation stimulation medications alone were more likely to be SGA than singleton infants conceived without treatment. No differences were found between ART and no treatment twin infants. Among singleton infants, ART is associated with decreased fetal growth, decreased gestational length, and SGA; ovulation stimulation alone is associated with SGA.

Osteomyelitis of the Temporal Bone in Identical Twin Infants

Osteomyelitis of the skull base almost always occurs in elderly patients with diabetes; however, it may occur in patients with compromised immune function regardless of their age. We present the cases of a pair of immunocompetent, 2-year-old identical twins who experienced osteomyelitis of the temporal bone almost exactly 1 year apart. An incident such as this, in this age group, has never been reported in the literature.

Spontaneous spinal epidural hematoma at the 16th week of a twin pregnancy

Spontaneous spinal epidural hematoma without discernable underlying conditions is a rare complication during pregnancy. We report a pregnant woman who developed the hematoma at 16 weeks of pregnancy; the earliest occurrence ever reported. A 36-year-old Japanese primipara with twins felt shoulder, neck and back pain at 16(+1) weeks with progressive quadriplegia. Magnetic resonance imaging revealed a mass in the C3-7 epidural space, compatible with a spinal epidural hematoma, and decompression was performed 9 h after symptom onset. Rehabilitation started and she gave birth abdominally to healthy twin infants at the 29th week. Motor, sensory and sphincter disturbances remained. This case demonstrates that spinal epidural hematoma can occur even without known underlying conditions and even at an early gestational age.

Pre-natal, clonal origin of t(1;11)(p32;q23) acute lymphoblastic leukemia in monozygotic twins

Aim Observation of identical genetic changes in leukemia cells from monozygotic twin pairs has provided evidence for the in utero single clonal origin hypothesis of leukemia, with intraplacental metastasis the basis for concordance. Investigation of this rare mixed lineage leukemia ( MLL) cytogenetic abnormality aims to provide further evidence of the genetic changes that underpin this aggressive form of leukemia in infants. Method The clinical features of a monozygotic infant twin pair with acute lymphoblastic leukemia (ALL) are reported. Banded chromosomal analysis and fluorescent in situ hybridization were used for cytogenetic characterization of the leukemic cells. Immunophenotype was determined by flow cytometry and polymerase chain reaction was used to determine the presence of FLT3-D835/I836 and FLT3-internal tandem duplication (ITD) mutations. Results The twins were seven weeks of age at diagnosis. Both had cytogenetic evidence for the t(1;11)(p32;q23) translocation. Trisomy X was present in a subpopulation of cells in one twin. Immunophenotypic profile at diagnosis was consistent with B precursor ALL (CD19, CD24, CD33 positive, weak CD13 positivity, CD10 negative) and both were negative for FLT3-D835/I836 and FLT3-ITD mutations. Conclusions This is the first report of monochorionic monozygotic twins harboring the t(1;11)(p32;q23) translocation. Identification of this rare translocation in both twins, indicates a common stem line and provides further evidence for the intrauterine monoclonal origin for infant ALL with concordance explained by the shared circulation. Genetic diversity was observed in a subpopulation of cells from one twin at diagnosis. We must now utilize the sophisticated molecular biology tools available to capture changes at the genome-wide level to gain further insight into the complex events contributing to MLL leukemogenesis in infants.

Neurodevelopmental Outcomes of Triplets or Higher-Order Extremely Low Birth Weight Infants

Extremely low birth weight twins have a higher rate of death or neurodevelopmental impairment than singletons. Higher-order extremely low birth weight multiple births may have an even higher rate of death or neurodevelopmental impairment. Extremely low birth weight (birth weight 401-1000 g) multiple births born in participating centers of the Neonatal Research Network between 1996 and 2005 were assessed for death or neurodevelopmental impairment at 18 to 22 months' corrected age. Neurodevelopmental impairment was defined by the presence of 1 or more of the following: moderate to severe cerebral palsy; mental developmental index score or psychomotor developmental index score less than 70; severe bilateral deafness; or blindness. Infants who died within 12 hours of birth were excluded. Maternal and infant demographic and clinical variables were compared among singleton, twin, and triplet or higher-order infants. Logistic regression analysis was performed to establish the association between singletons, twins, and triplet or higher-order multiples and death or neurodevelopmental impairment, controlling for confounding variables that may affect death or neurodevelopmental impairment. Our cohort consisted of 8296 singleton, 2164 twin, and 521 triplet or higher-order infants. The risk of death or neurodevelopmental impairment was increased in triplets or higher-order multiples when compared with singletons (adjusted odds ratio: 1.7 [95% confidence interval: 1.29-2.24]), and there was a trend toward an increased risk when compared with twins (adjusted odds ratio: 1.27 [95% confidence: 0.95-1.71]). Triplet or higher-order births are associated with an increased risk of death or neurodevelopmental impairment at 18 to 22 months' corrected age when compared with extremely low birth weight singleton infants, and there was a trend toward an increased risk when compared with twins.

Timing of birth for women with a twin pregnancy at term: a randomised controlled trial.

BackgroundThere is a well recognized risk of complications for both women and infants of a twin pregnancy, increasing beyond 37 weeks gestation. Preterm birth prior to 37 weeks gestation is a recognized complication of a twin pregnancy, however, up to 50% of twins will be born after this time.The aims of this randomised trial are to assess whether elective birth at 37 weeks gestation compared with standard care in women with a twin pregnancy affects the risk of perinatal death, and serious infant complications.Methods/DesignDesign: Multicentred randomised trial.Inclusion Criteria: women with a twin pregnancy at 366 weeks or more without contraindication to continuation of pregnancy.Trial Entry & Randomisation: Following written informed consent, eligible women will be randomised from 36+6 weeks gestation. The randomisation schedule uses balanced variable blocks, with stratification for centre of birth and planned mode of birth. Women will be randomised to either elective birth or standard care.Treatment Schedules: Women allocated to the elective birth group will be planned for elective birth from 37 weeks gestation. Where the plan is for vaginal birth, this will involve induction of labour. Where the plan is for caesarean birth, this will involve elective caesarean section. For women allocated to standard care, birth will be planned for 38 weeks gestation or later. Where the plan is for vaginal birth, this will involve either awaiting the spontaneous onset of labour, or induction of labour if required. Where the plan is for caesarean birth, this will involve elective caesarean section (after 38 and as close to 39 weeks as possible).Primary Study Outcome: A composite of perinatal mortality or serious neonatal morbidity.Sample Size: 460 women with a twin pregnancy to show a reduction in the composite outcome from 16.3% to 6.7% with adjustment for the clustering of twin infants within mothers (p = 0.05, 80% power).DiscussionThis is a protocol for a randomised trial, the findings of which will contribute information about the optimal time of birth for women with an uncomplicated multiple pregnancy at and beyond 37 weeks gestation.Clinical Trial RegistrationCurrent Controlled Trials ISRCTN15761056

Hemolytic Disease of the Newborn Associated with Anti-JraAlloimmunization in a Twin Pregnancy: The First Case Report in Korea

Jr(a) is a high-frequency antigen found in all ethnic groups. However, the clinical significance of the anti-Jr(a) antibody has remained controversial. Most studies have reported mild hemolytic disease of the newborn and fetus (HDNF) in Jr(a)-positive patients. Recently, fatal cases of HDNF have also been reported. We report the first case of HDNF caused by anti-Jr(a) alloimmunization in twins in Korea. A 33-yr-old nulliparous woman with no history of transfusion or amniocentesis was admitted at the 32nd week of gestation because of vaginal bleeding caused by placenta previa. Anti-Jr(a) antibodies were detected in a routine laboratory examination. An emergency cesarean section was performed at the 34th week of gestation, and 2 premature infant twins were delivered. Laboratory examination showed positive direct antiglobulin test and Jr(a+) phenotype in the red blood cells and the presence of anti-Jr(a) antibodies in the serum in both neonates. The infants underwent phototherapy for neonatal jaundice; this was followed by conservative management. They showed no further complications and were discharged on the 19th postpartum day. Preparative management to ensure the availability of Jr(a-) blood, via autologous donation, and close fetal monitoring must be performed even in cases of first pregnancy in Jr(a-) women.

Chromatic (Red/Green) and Luminance Contrast Sensitivity in Monozygotic and Dizygotic Twin Infants

Purpose: To determine the extent to which contrast sensitivity (CS) development is governed by genetic mechanisms vs. environment, we compared CS between pairs of twin infants and pairs of unrelated infants. If genetics have a strong influence on CS, Monozygotic (Mz) twin siblings should be more similar (and more strongly correlated) than Dizygotic (Dz) twin siblings, and both Mz and Dz twins should show greater correlations than unrelated infant pairs. By contrast, if genetics have little influence, correlations should be the same for Dz and Mz twins. In this latter scenario, if both Mz and Dz twins show greater correlations than unrelated infant pairs, this suggests a role of shared environment. The current study measured Luminance (light/dark) and Chromatic (red/green) CS to assess sensitivity of the Magnocellular and Parvocellular pathways, respectively. Methods: Ten and 26 pairs of Mz and Dz twin pairs were tested (mean age = 4.5±1.5 mos). Zygosity was assessed using a questionnaire and cheek swab kits. Luminance and Chromatic CS were obtained for sinusoidal gratings using forced-choice preferential looking (∼200 trials per infant; 0.27 cycles/degree; 4.2 Hz). Results: Multiple regression was conducted on 100 runs of random Twin-1/Twin-2 orderings. Results indicated that the CS of one twin predicted 35-40% of the variance (p <0.0001) in the CS of the other twin, while controlling for postnatal age, gestational length, and gender. Simulations with randomly-matched twins suggest these findings are not due to chance. Discussion: Results suggest shared environment and/or genes influence both Luminance and Chromatic CS. With more subjects, we will address whether Luminance vs. Chromatic CS is more or less affected by shared genes/environment. Once we have enough data to compare Mz vs. Dz twins, we can ask which factor, genes or environment, is more influential using structural equation modeling (Neale et al, 2002).

The prevalence of cobedding and SIDS-related child care practices in twins

Sudden unexplained and unexpected death in twins has not been well studied, particularly in relation to the common practice of sleeping twin infants together in the same cot (cobedding). Postal surveys of 109 mothers of twins were undertaken when the infants were 6 weeks, 4 months, and 8 months of age to determine the prevalence of cobedding, infant care practices related to sudden infant death syndrome (SIDS), and the mother's knowledge of SIDS risk factors. SIDS risk factor knowledge was similar to an earlier survey of singletons in 2005. At 6 weeks, 76% of infants usually slept on the back; this changed to 86% at 4 months and 73% at 8 months. At 6 weeks, 52% usually cobedded with their twin all or part of the time. At 4 and 8 months, this had reduced to 31% and 10%, respectively. Side-by-side cobedding configurations were predominant at 6 weeks, with feet-to-feet configurations increasing as the infants grew older. Breastfeeding was reported in 83%, 61% and 31% of infants at 6 weeks, 4 months and 8 months, respectively. Pacifier use was reported in 38%, 50% and 33% at the respective surveys. As the age of the twins increased, mothers were significantly more likely to be concerned about deformational plagiocephaly in Twin 1 than in Twin 2. Despite a lack of evidence of the risks or benefits of cobedding, this practice was very popular, especially in the younger infants. More research is needed to establish the safety of cobedding in relation to the risk of SIDS.

There Is Always Something New Out of Africa

Lone survivor of seven sets of twins born to his mother, he started life as a legend among the Yoruba in Nigeria, who have one of the highest rates of twin births and infant deaths in the world. According to family lore, he was the spirit that kept trying to be born and kept being turned back, the child "born to die." Bamidele to his father, Olaniyi to his grandmother, Prince Twins Seven-Seven renamed himself in adulthood to commemorate newly found royal lineage and the circumstances of his birth, which colored his life and shaped his art. Deeply conscious of these aspects of his nature, he has conveyed in art his personal understanding of a world teeming with spirits and populated with myths.

Kidney growth in twin children born small for gestational age

Low birth weight (LBW) is associated with adult-onset diseases, including hypertension and renal disease; altered renal development after intrauterine growth restriction (IUGR) may underlie related prenatal programming. No data are available on longitudinal renal growth in twin infants born small for gestational age (SGA). The aim of this prospective longitudinal study was to estimate the renal size during the first 2 years of life in SGA twin infants. The study included 613 children, of which 145 were SGA twins, 141 twins appropriate for gestational age (AGA), 148 matched AGA singletons and 179 matched SGA singletons, classified according to GA into two groups (28-36 and >36 weeks). The SGA children were also classified according to the degree of IUGR: birth weight (BW) <3rd percentile and BW 3rd-10th percentiles. Serial renal ultrasonography (US) for kidney length (KL) measurement was performed at the ages of 36 and 40 weeks corrected age (CA) and 3, 6, 12 and 24 months of age, and KL was related to other anthropometric indices. Twin data were examined both as individuals and as members of twin pairs. A total of 2317 measurements were performed. KL was lower at 40 weeks CA in all the SGA twin subgroups. In the SGA twins with GA >36 weeks, KL increased thereafter and became similar to AGA twins and single AGA control subjects. Among pre-term infants of GA <36 weeks, only those with BW 3rd-10th percentile experienced catch-up in KL, while in those with BW <3rd percentile, KL remained lower than in AGA infants throughout the study period, both in absolute terms and relative to other anthropometric indices. No differences in KL were found between twin SGA and singleton SGA or between twin AGA and singleton AGA infants. Intrapair BW differences were correlated with the intrapair differences in KL. Twin SGA infants born prematurely with BW <3rd percentile are unable to achieve catch-up in KL in the first 24 months of life, and long-term follow-up is recommended.

Neonate twin with staphylococcal scalded skin syndrome from a renal source

To understand the underlying mechanism of exfoliative toxins causing staphylococcal scalded skin syndrome or Ritter's Disease that predominantly affects newborns and infants, although it is sometimes found in adults. Staphylococcal scalded skin syndrome is typically diagnosed by the characteristic fluid-filled bullae together with superficial skin loss. A histopathological diagnosis may be made by looking for subcorneal acantholytic cleavage with minimal inflammation on biopsy, although this is not normally required. Exfoliative toxin A and B are both responsible for the "acantholytic" infection of Staphylococcus aureus as they target desmoglein-1 leading to loss of cell-to-cell cohesion and subsequent spread of infection. Other factors produced by S. aureus can cause a myriad of other problems including neutralization of antimicrobial peptides, inactivation of neutrophils, proteolysis, T-cell anergy, and immunosuppression. Individual care report. Pediatric intensive care unit. We describe a normal male infant who was born at term and developed 100% total body surface area staphylococcal scalded skin syndrome on the 14 day of life with associated renal sepsis. After cultures from the lesions, bloodstream, and urine were obtained, intravenous Vancomycin and Ceftriaxone were commenced. The initial lesions increased in size over a 36-hr period to cover the entire body surface; this was associated with a decline in hemodynamic status. Cultures from the urine and blood grew coagulase-positive S. aureus. An ultrasound scan revealed bilateral pyonephroses, which necessitated the placement of percutaneous nephrostomies with subsequent decompression of the collecting system. After the decompression hemodynamic status stabilized and over the ensuing 10 days, the patient made a full recovery with no scarring. No similar lesions were noticed on the infant's twin brother. We discuss the recent developments in understanding the underlying mechanism of exfoliative toxins causing staphylococcal scalded skin syndrome, review current treatment guidelines, and outline the need for new therapeutic options.

Breastfeeding in Preterm and Term Twins—Maternal Factors Associated With Early Cessation: A Population-Based Study

To investigate the duration of breastfeeding and the impact of maternal factors for cessation of breastfeeding in twin infants, the authors undertook a population-based cohort study. Breastfeeding data obtained from Child Health Centres were matched with data on infant and maternal demographics from Swedish national registers. A total of 1.657 twins were included, of whom 695 were born preterm. Breastfeeding frequencies in preterm twins were 79% at 2 months, 58% at 4 months, 39% at 6 months, 14% at 9 months, and 6% at 12 months. In term twins, the corresponding frequencies were 84%, 63%, 45%, 18%, and 6%, respectively. In both preterm and term mothers, mothers who had a lower educational level or smoked at first antenatal care visit were subject to earlier cessation of breastfeeding by 6 months of age. In addition, in mothers of term infants, mothers who were < 23 years old or primiparous had a higher risk for cessation of breastfeeding before 6 months. Thus, mothers of twins have a good potential to breastfeed, but additional support is needed for those more susceptible to early cessation of breastfeeding.