Association between intrauterine growth restriction and patent ductus arteriosus: Use of a dichorionic twin pregnancy model.

OBJECTIVE: To evaluate the association between intrauterine growth restriction (IUGR) and the incidence of fetuses with patent ductus arteriosus (PDA) and Hemodynamically significant PDA (Hs-PDA) in dichorionic twins (DC) with selective IUGR. MATERIALS AND METHODS: This is an observational cohort study and retrospective case assessment, involved twins born at Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan between 2013 and 2018. DC twins with selective IUGR (sIUGR) were defined as the presence of a birth weight discordance of >25% and a smaller twin with a birth weight below the tenth percentile. PDA was diagnosed using echocardiography between postnatal day 3 and 7. Hs-PDA was defined as PDA plus increased pulmonary circulation, poor systemic perfusion, cardiomegaly, pulmonary edema, or hypotension requiring pharmacotherapeutic intervention. RESULT: A total of 1187 twins were delivered during the study period, and 53 DC twins with selective IUGR were included in this study. DC twins with PDA have higher rate of preterm birth, lower gestational age of delivery, and lower mean birth weight of both twins compared with DC twins without PDA. In a comparison of the sIUGR twin with the appropriate for gestational age co-twin, both the incidences of PDA (28.30% vs. 7.55%, respectively; P = 0.003) and Hs-PDA (24.53% vs. 5.66%, respectively; P = 0.002) were higher in sIUGR fetuses than in the appropriate for gestational age co-twins. Small gestational age of delivery was the only variable to predict PDA and Hs-PDA [p = 0.002, Odds ratio = 0.57 (0.39-0.82), p = 0.009, Odds ratio = 0.71 (0.55-0.92), respectively]. CONCLUSION: An analysis of dichorionic twins with sIUGR indicated that IUGR increased the risk of PDA and hemodynamically significant PDA.

Prospective investigation of serial ultrasound for transient tachypnea of the newborn.

BACKGROUND: Transient tachypnea of the newborn (TTN), which is diagnosed using typical clinical course and radiographic findings, is the most common cause of respiratory distress in late-preterm and term neonates. Lung ultrasound (LUS) is increasingly used to identify TTN according to the distinct characteristics of the disease. However, few studies have reported the application of LUS to monitor the clinical evolution of TTN. Using serial LUS, this prospective study assessed and monitored TTN severity. METHODS: From November 2018 to October 2019, neonates ≥34 weeks of gestation admitted to the newborn center of Chang Gung Memorial Hospital were enrolled. Neonates diagnosed with TTN and requiring respiratory support comprised the TTN group (n = 29), whereas those without respiratory disease served as the control group (n = 23). LUS was performed and scored in both groups within 4 h of admission and followed up at 24 and 48 h. RESULTS: A total of 65 infants were screened for enrollment and 13 were excluded. Most of the enrollees in both groups exhibited a peak LUS score on the first day, which then gradually declined thereafter. In comparison with the control group, the LUS score of the TTN group was higher on day 1 and day 2, and it had a significantly greater decrease from day 1 to day 2. In the TTN group, LUS scores moderately correlated with respiratory severity scores. CONCLUSION: We conducted a serial and quantitative LUS investigation in late-preterm and term infants with TTN. The LUS score mirrored the respiratory status relatively well, and it can help to monitor the clinical course of TTN, in the case of either resolution or deterioration.