Necrotizing enterocolitis in monochorionic twins: Insights from an identical twin model

Area of Science:

• Neonatalogy
• Pediatric Gastroenterology
• Perinatology

Background:

• Necrotizing enterocolitis (NEC) is a significant cause of illness and death in premature infants.
• The exact causes of NEC are not fully understood.
• Identical twins offer a unique model to study NEC risk factors by controlling for genetic and maternal variables.

Purpose of the Study:

• To investigate risk factors for NEC in preterm neonates.
• To utilize an identical twin model to isolate specific contributing factors to NEC.
• To compare outcomes between affected and unaffected twins within monochorionic pairs.

Main Methods:

• A case-control study analyzing monochorionic twin pairs born between 2002 and 2020.
• Retrospective review of medical records to identify NEC cases.
• Within-pair analysis comparing affected twins with their unaffected co-twins.

Main Results:

• Twins diagnosed with NEC had significantly lower birth weights than their co-twins (1100g vs. 1339g).
• Twin pairs with NEC had lower gestational ages (29.1 weeks vs. 33.6 weeks) and birth weights (1221g vs. 1865g) compared to non-NEC pairs.
• Twin pregnancies with NEC were more frequently complicated by twin-to-twin transfusion syndrome, especially after amnioreduction (70% vs. 49%).

Conclusions:

• Lower birth weight is a key risk factor for NEC in preterm neonates.
• This finding holds true even among identical twins, indicating its importance beyond shared genetics and maternal factors.
• Twin-to-twin transfusion syndrome may also increase NEC risk in affected pregnancies.