Neonatal Outcomes Among Survivors of Twin-twin Transfusion Syndrome After Single Fetal Demise

Twin-twin transfusion syndrome (TTTS) is due to unbalanced inter-twin blood flow. We aimed to evaluate neonatal outcomes among surviving co-twins of TTTS without fetal laser photocoagulation after single-twin intrauterine fetal demise (sIUFD). All patients admitted between January 2014 and December 2017 to the neonatal intensive care unit of a medical center were recruited. Moreover, a comprehensive literature review of PubMed from 1993 to 2020 was performed. Medical records of 124 patients were retrieved, including 119 from published literature and five from our institution. Seventy-three (58.8%) patients were born prematurely. In addition, twenty-four (19.3 %) patients presented with anemia at birth, and seventeen (13.7%), four (3.2%), and four (3.2%) neonates had intracranial lesions, acute kidney injury, and gastrointestinal (GI) tract dysmotility, respectively. The overall survival rate was 69.4 %. Among our cases, we found that the hemoglobin level at birth was positively correlated with the duration between co-twin intrauterine fetal demise and the delivery time of the surviving co-twins (rs=0.9, p=0.037). Conclusions: High morbidity and mortality rates were observed among co-twins of TTTS after sIUFD without laser photocoagulation. The shorter duration between diagnosis of sIUFD and surviving twin delivery resulted in more severe anemia.