ACUTE AND CHRONIC FETOFETAL TRANSFUSION SYNDROME

Background In the fetofetal transfusion syndrome we can discriminate b etween a chronic form with severe difference in weight and an acute fo rm with a difference in haemoglobin between the twins. The aim of the retrospective study was to investigate the influence of both forms reg arding infant morbidity and mortality. Patients Of the 135 twins treat ed from 1.1.1984 to 31.12. 1993 in the Department of Pediatrics at the Christian-Albrechts-University Kiel, 27 (20%) showed evidence of feto fetal transfusion. Results Twelve (8.8%) fullfilled the criteria for a n acute and 10 (7.4%) for a chronic transfusion. In 5 (3.9%) twins bot h forms were evident. Clear differences between twins with acute or ch ronic fetofetal transfusion syndrome could be seen in gestational age and birth weight. The twins with an acute fetofetal transfusion were s ignificantly older (median: 31.5 vs. 29.0 weeks of gestation), and hea vier (median: 1900 vs. 1020 g). Furthermore this group faired signific antly better statistically when compared to the chronic form as regard s the incidence of mortality (7 vs. 0), the Respiratory Distress Syndr ome grades III and IV (7 vs. 2) persistent ductus arteriosus (13 vs 9) , intraventriculare haemorrhage (14 vs 6) and posthaemorrhagic hydroce phalus (4 vs 0). Similar significant differences could be seen as rega rds mortality, the Respiratory Distress Syndrome. and intraventricular haemorrhage when acute fetofetal transfusion was compared with the co mbined acute on chronic form. No significant difference regarding neon atal morbidity and mortality, however, could be shown between infants having undergone chronic fetofetal transfusion and infants with the co mbined acute on chronic form. Conclusions It can be concluded that twi ns with chronic fetofetal transfusion show a higher rate of neonatal m orbidity and mortality, wheras, the acute form does not significantly influence these factors. As both forms not only differ in onset of the disease, pathogenesis, and the actual course of the disease. It is im portant to always differenciate between the acute and chronic forms.