Twin-to-twin transfusion syndrome as a cause of neonatal acute liver failure
, and | Mar 31, 2020
About this article
Article Category: Clinical report
Published Online: Mar 31, 2020
Page range: 163 - 170
DOI: https://doi.org/10.1515/abm-2019-0055
Keywords
© 2019 Chattip Prueksapraopong et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.
Figure 1
![General management of NALF [15, 16, 18]. *Hypertonic saline (3%–30%) is preferred over mannitol in management of ICH.There is no enough evidence to support the use of mannitol and therapeutic hypothermia in NALF.PT, prothrombin time; INR, international normalized ratio; q, every; h, hours; LFT, liver function test; BUN, blood urea nitrogen; Cr, serum creati-nine; Ca, calcium; PO, phosphate; ETT, endotracheal tube; HTS, hypertonic saline; Na, sodium; ICH, intracranial hypertension; GAL-1-PUT, Galactose 1-phosphate uridyl transferase; IV, intravenously; HSV, Herpes simplex virus; SIRS, systemic inflammatory response syndrome; ATB, antibiotics; FFP, fresh frozen plasma; PPI, proton pump inhibitor](https://sciendo-parsed.s3.eu-central-1.amazonaws.com/6470679b83f1392090d68d25/j_abm-2019-0055_fig_001.jpg?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Date=20240520T090539Z&X-Amz-SignedHeaders=host&X-Amz-Expires=18000&X-Amz-Credential=AKIA6AP2G7AKP25APDM2%2F20240520%2Feu-central-1%2Fs3%2Faws4_request&X-Amz-Signature=13f601bd520b5e8a91dc76bb7cb167278d66f5cb5a46077389829fcbd7ec8a81)
Diagnostic criteria and severity staging (Quintero staging system) of TTTS [3, 5, 6]
Presence of a monochorionic diamniotic pregnancy Polyhydramnios in the recipient with DVP of ≥8 cm and oligohydramnios in the donor with DVP < 2 cm | DVP < 2 cm in donor sac; DVP > 8 cm in recipient sac The bladder is no longer visible in the donor twin Critically abnormal Doppler in either twin: absent/reverse diastolic flow in the umbilical artery of the donor or recipient and/or absent/reverse flow in the ductus venosus or pulsatile flow in the umbilical vein of the recipient Hydrops in either fetus Demise of one or both twins |
Causes of neonatal liver failure, assessment methods, and results
| Syphilis | Quantitative non-treponemal serological test | Negative |
| Toxoplasmosis | Serology (IgG and IgM) | IgG less than 1:16; IgM negative |
| Rubella | Serology (IgG and IgM) | Negative |
| Cytomegalovirus | Blood and urinary PCR | Negative |
| Herpes simplex virus | Blood PCR | Negative |
| Varicella virus | Blood PCR | Negative |
| Infection/sepsis | Blood culture | No growth |
| Hepatitis viruses A, B, and C | Serology (IgG and IgM) | Negative |
Laboratory results
| Hct (%) | 46.1 | 36.7 | 50.4 | 42.2 | 35.4 | 40.5 | 39.3 | 32.9 | 40 | 41 | 34.6 | 32.4 | 31 | 36.2 | 34.3 |
| Platelet (cell/mm3) | 132K | 97K | 105K | 77K | 69K | 75K | 81K | 62K | 45K | 120K | 85K | 79K | 88K | 75K | 82K |
| AST (U/L) | 4,580 | 4,290 | – | 267 | 156 | 72 | 44 | 29 | 30 | – | 28 | – | – | – | 47 |
| ALT (U/L) | 792 | 650 | – | 193 | 166 | 111 | 86 | 57 | 51 | – | 24 | – | – | – | 18 |
| ALP (U/L) | 232 | 227 | – | 215 | 262 | 309 | 319 | 302 | 369 | – | 372 | – | – | – | 369 |
| TP (g/dL) | 5.8 | 6.3 | – | 10.20 | 5.7 | 6.1 | 6.3 | 7.6 | 7.2 | – | 7.7 | – | – | – | 7.4 |
| Alb (g/dL) | 2.6 | 3.1 | – | 2.6 | 2.7 | 2.8 | 2.9 | 4.3 | 2.9 | – | 3.2 | – | – | – | 3.2 |
| Glb (g/dL) | 3.2 | 3.2 | – | 3.2 | 3.0 | 3.3 | 3.4 | 3.3 | 4.3 | – | 4.5 | – | – | – | 4.2 |
| TB (mg/dL) | 2.19 | 4.46 | – | 5.8 | 12.72 | 12.38 | 10.22 | 7.6 | 6.68 | – | 8.43 | – | – | – | 13.57 |
| DB (mg/dL) | 0.30 | 0.37 | – | 1.60 | 3.08 | 5.06 | 4.68 | 4.3 | 4.3 | – | 5.64 | – | – | – | 9.09 |
| IDB (mg/dL) | 1.89 | 3.09 | – | 8.60 | 9.64 | 7.32 | 5.54 | 3.3 | 2.3 | – | 2.79 | – | – | – | 4.48 |
| Fibrinogen | – | – | 76.0 | 103.3 | 142.1 | – | – | 147.9 | 172.3 | 233.2 | 204 | – | – | – | 211 |
| PT (s) (13.5–16.4) | 38.9 | 45.3 | 39.1 | 27.6 | 25.0 | – | 23.0 | 17.2 | 18.5 | 18 | 16.4 | 15.7 | 15.7 | 15 | 15.6 |
| PTT (s) (29.5–42.2) | 42.8 | 43.9 | 56.6 | 54.6 | 53.7 | – | 51.0 | 36.5 | 44.1 | 47.3 | 46.1 | 45.2 | 51.3 | 43.7 | 44.6 |
| INR (1.05–1.35) | 3.50 | 4.11 | 3.52 | 2.44 | 2.20 | – | 2.02 | 1.49 | 1.6 | 1.56 | 1.41 | 1.35 | 1.35 | 1.29 | 1.34 |
| LP-PRC | – | 15 mL/kg · 1 | – | – | – | – | – | 10 mL/kg · 1 | – | – | – | – | 10 mL/kg · 1 | – | – |
| LP-Plt | – | 10 mL/kg · 1 | – | 10 mL/kg · 1 | 10 mL/kg · 1 | 10 mL/kg · 1 | – | – | 15 mL/kg · 1 | – | – | – | – | – | – |
| Cryo | – | – | 1 unit | 1 unit | 1 unit | – | – | 1 unit | 1 unit | – | – | – | – | – | – |
| FFP | – | 10 mL/kg · 3 | 10 mL/kg · 3 | 10 mL/kg · 2 | 10 mL/kg · 2 | 10 mL/kg · 2 | 10 mL/kg · 2 | 10 mL/kg · 2 | 15 mL/kg · 1 | 15 mL/kg · 1 | 15 mL/kg · 1 | – | 10 mL/kg · 1 | – | – |