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Published on: September 5, 2011
Vasoactive Management of Pulmonary Hypertension and Ventricular Dysfunction in Neonates Following Complicated
Lukas Schroeder1, Leon Soltesz1, Judith Leyens1
1Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
Insights
Neonates from complicated monochorionic twin pregnancies frequently develop pulmonary hypertension and cardiac dysfunction. Individualized vasoactive treatment is crucial for managing these high-risk infants.
Area of Science:
- Neonatal cardiology and intensive care
- Perinatal medicine
- Twin pregnancy complications
Background:
- Monochorionic (MC) twin pregnancies carry risks for neonates, including postnatal pulmonary hypertension (PH) and cardiac dysfunction (CD).
- These conditions contribute significantly to both short-term and long-term infant morbidity.
- Evaluating the necessity and patterns of vasoactive treatment in this population is critical.
Purpose of the Study:
- To retrospectively evaluate the need for vasoactive treatment in neonates born from complicated MC twin pregnancies.
- To assess the incidence and evolution of PH and CD in these infants.
- To compare treatment strategies between donor and recipient twins.
Main Methods:
- Retrospective single-center cohort study of in-born neonates from complicated MC twin pregnancies.
- Inclusion criteria: admission to the University Children's Hospital Bonn (UKB) neonatology department (October 2019 - December 2023).
- Analysis included 70 neonates: 37 recipient twins (Group A) and 33 donor twins (Group B).
Main Results:
- Overall PH incidence was 17% at Day of Life (DOL) 1, decreasing to 6% by DOL 7 (p=0.013).
- Cardiac dysfunction (CD) incidence was 56% at DOL 1, significantly decreasing to 10% by DOL 7 (p=0.015).
- Vasoactive medication use varied, with higher milrinone dosing in donor twins (Group B) at DOL 1 (p=0.043); levosimendan and beta-blockers were frequently used.
Conclusions:
- Early PH and CD are common in neonates following complicated MC twin pregnancies.
- An individualized approach to vasoactive treatment is essential for managing these infants.
- Further research into specific treatment strategies for donor versus recipient twins may be warranted.
Objectives:
Twins resulting from a complicated monochorionic (MC) twin pregnancy are at risk for postnatal evolution of pulmonary hypertension (PH) and cardiac dysfunction (CD). Both pathologies are important contributors to short- and long-term morbidity in these infants. The aim of the present retrospective single-center cohort study was to evaluate the need for vasoactive treatment for PH and CD in these neonates.
Methodology:
In-born neonates following a complicated MC twin pregnancy admitted to the department of neonatology of the University Children's Hospital Bonn (UKB) between October 2019 and December 2023 were screened for study inclusion. Finally, 70 neonates were included in the final analysis, with 37 neonates subclassified as recipient twins (group A) and 33 neonates as donor twins (group B).
Results:
The overall PH incidence at day of life (DOL) 1 was 17% and decreased to 6% at DOL 7 (p = 0.013), with no PH findings at DOL 28. The overall incidence of CD was 56% at DOL 1 and decreased strongly until DOL 7 (10%, p = 0.015), with no diagnosis of CD at DOL 28. The use of dobutamine, norepinephrine, and vasopressin at DOL 1 until DOL 7 did not differ between the subgroups, whereas the dosing of milrinone was significantly higher in Group B at DOL 1 (p = 0.043). Inhaled nitric oxide (iNO) was used in 16% of the cohort, and a levosimendan therapy was administered in 34% of the neonates. One-third of the cohort was treated with oral beta blockers, and in 10%, an intravenous beta blockade (landiolol) was administered. The maximum levosimendan vasoactive-inotropic score (LVISmax) increased from DOL 1 (12.4 [3/27]) to DOL 2 (14.6 [1/68], p = 0.777), with a significant decrease thereafter as measured at DOL 7 (9.5 [2/30], p = 0.011).
Conclusion:
Early PH and CD are frequent diagnoses in neonates following a complicated MC twin pregnancy, and an individualized vasoactive treatment strategy is required in the management of these infants.
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