Multiple organ failure syndrome in the neonatal period in preterm newborns from monochorionic twins (literature review)
https://doi.org/10.24884/2078-5658-2026-23-1-128-135
Abstract
This literature review systematizes current knowledge about the epidemiology and clinical features of newborns from multiple pregnancies with monochorionic placentation. The specific complications characteristic of this group are highlighted, namely twin-twin transfusion syndrome, anemia-polycythemia syndrome and selective fetal growth retardation syndrome. Modern approaches to the diagnosis and prognosis of multiple organ failure syndrome in this category of patients, such as the nSOFA and NEOMOD scales, are considered. However, these systems do not have sufficient flexibility to assess the health status of this group of patients, which underscores the need for further research on predictors of the development of multiple organ failure syndrome. In particular, it is relevant to study the acid-base state and gas homeostasis of blood in the neonatal period in newborns from monochorionic twins, which is an urgent task for optimizing perinatal care.
About the Authors
A. I. Davydenko
Ural Research Institute of Maternity and Child Care
Russian Federation
Russian Federation
Davydenko Aleksey I., Anesthesiologist and Intensivist of the Department of Neonatal Resuscitation and Intensive Care, Full-Time Postgraduate Student
1, Repina str., Ekaterinburg, 620028
S. V. Kinzhalova
Ural Research Institute of Maternity and Child Care
Russian Federation
Russian Federation
Kinzhalova Svetlana V., Dr. of Sci. (Med.), Associate Professor, Head of the Scientific Department of Resuscitation and Intensive Care
AuthorID: 570815
1, Repina str., Ekaterinburg, 620028
S. Yu. Zakharova
Ural Research Institute of Maternity and Child Care
Russian Federation
Russian Federation
Zakharova Svetlana Yu., Dr. of Sci. (Med.), Professor, Leading Research Fellow of the Department of Physiology and Pathology of Newborns and Infants
AuthorID: 325786
1, Repina str., Ekaterinburg, 620028
R. A. Makarov
Ural Research Institute of Maternity and Child Care
Russian Federation
Russian Federation
Makarov Roman A., Cand. of Sci. (Med.), Senior Research Fellow, Department of Resuscitation and Intensive Care
AuthorID: 132340
1, Repina str., Ekaterinburg, 620028
M. V. Pavlichenko
Ural Research Institute of Maternity and Child Care
Russian Federation
Russian Federation
Pavlichenko Maria V., Cand. of Sci. (Med.), Head of the Department of Physiology and Pathology of Newborns and Infants
AuthorID: 664703
1, Repina str., Ekaterinburg, 620028
References
1. Bugerenko A. E. Twin-to-twin transfusion syndrome: a modern view. Russian Bulletin of Obstetrician-Gynecologist, 2021, vol. 21, no. 5, pp. 15–21. (In Russ.). http://doi.org/10.17116/rosakush20212105115.
2. Golomidov A. V., Grigoriev E. V., Moses V. G., Moses K. B. Multiple organ dysfunction syndrome prediction in newborn children. Innovative Medicine of Kuban, 2022, no. 1, pp. 83–89. (In Russ.). http://doi.org/10.35401/2500-0268-2022-25-1-83-89.
3. Kalashnikov S. A. Parameters of neonate serum acid-base state and gas composition in multifetal pregnancy. Obstetrics, Gynecology and Reproduction, 2020, vol. 14, no. 6, pp. 612–621. (In Russ.). http://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.175.
4. Kosovtsova N. V., Markova T. V., Pospelova Ya. Yu. et al. Experience in Laser Coagulation of Placentary Anastomoses in Selective Foetal Growth Retardation. Doctor.ru, 2022, vol. 21, no. 5, pp. 43–46. (In Russ.). http://doi.org/10.31550/1727-2378-2022-21-5-43-46.
5. Kostyukov K. V., Ionov O. V., Shakaya M. N. Assessment of perinatal outcomes in the discordant weight of newborns from twins. Akusherstvo i ginekologiya, 2020, no. 5, pp. 78–84. (In Russ.). http://doi.org/10.18565/aig.2020.5.78-84.
6. Logutova L. S., Shilkina P. S. Modern aspects of the diagnosis and correction of feto-fetal transfusion syndrome in multifetal monochorial pregnancy. Russian Bulletin of Obstetrician-Gynecologist, 2020, vol. 20, no. 3, pp. 11–17. (In Russ.). http://doi.org/10.17116/rosakush20202003111.
7. Markova T. V., Kosovtsova N. V., Kuklin E. S. et al. Modern ideas about the syndr ome of anemia-polycythemia in monochorionic multiple pregnancy (TAPS). Akusherstvo i ginekologiya, 2019, no. 7, pp. 24–29. (In Russ.). http://doi.org/10.18565/aig.2019.7.24-29.
8. Mironov P. I., Lekmanov A. U. Evaluation of the validity of the nSOFA score in newborns with sepsis. Messenger of Anesthesiology and Resuscitation, 2021, vol. 18, no. 2, pp. 56–61. (In Russ.) http://doi.org/10.21292/2078-5658-2021-18-2-56-61.
9. Pavlichenko M. V., Kosovtsova N. V., Pospelova Ya. Yu., Markova T. V. Perinatal outcomes in a combination of feto-fetal transfusion syndrome and selective fetal growth retardation syndrome in monochorionic twins. Russian Bulletin of Obstetrician-Gynecologist, 2022, vol. 22, no. 6, pp. 68–75. (In Russ.). http://doi.org/10.17116/rosakush20222206168.
10. Perepelitsa S. A. Acute respiratory distress syndrome in preterm newborns (morphological study). General reanimatology/Obshchaya reanimatologya, 2020, vol. 16, no. 1, pp. 35–44. (In Russ.) http://doi.org/10.15360/1813-9779-2020-1-35-44.
11. Perepelitsa S. A. Etiologic and pathogenetic perinatal factors for the development of intrauterine infections in newborns (review). General reanimatology/Obshchaya reanimatologya, 2018, vol. 14, no. 3, pp. 54–67. (In Russ.) http://doi.org/10.15360/1813-9779-2018-3-54-67.
12. Romanovsky A. N., Mikhailov A. V., Kashtanova T. A. et al. Monochorionic monoamniotic multiple pregnancy – main complications and management. Akusherstvo i ginecologiia Sankt-Peterburga, 2019, no. 1, pp. 14–18.
13. Adegbite A. L., Castille S., Ward S. et al. Neuromorbidity in preterm twins in relation to chorionicity and discordant birth weight // Am J Obstet Gynecol. – 2004. – № 190. – P. 156–163. http://doi.org/10.1016/j.ajog.2003.07.004.
14. Axelsdóttir Í., Ajne G. Short-term outcome of the second twin during vaginal delivery is dependent on delivery time interval but not chorionicity // J Obstet Gynaecol. – 2019. – Vol. 39, № 3. – P. 308–312. http://doi.org/10.1080/01443615.2018.1514490.
15. Chmait R. H., Chon A. H., Schrager S. M. et al. Neonatal cerebral lesions predict 2-year neurodevelopmental impairment in children treated with laser surgery for twin-twin transfusion syndrome // J Matern Fetal Neonatal Med. – 2019. – Vol. 32, № 1. – P. 80–84. http://doi.org/10.1080/14767058.2017.1371694.
16. Cnattingius S., Johansson S., Razaz N. Associations between metabolic acidosis at birth and reduced Apgar scores within the normal range (7–10): A Swedish cohort study of term non-malformed infants // Paediatr Perinat Epidemiol. – 2020. – Vol. 34, № 5. – P. 572–580. http://doi.org/10.1111/ppe.12663.
17. Colmant C., Lapillonne A., Stirnemann J. et al. Impact of different prenatal management strategies in shortand long-term outcomes in monochorionic twin pregnancies with selective intrauterine growth restriction and abnormal flow velocity waveforms in the umbilical artery Doppler: a retrospective observational study of 108 cases // BJOG. – 2021. – Vol. 128, № 2. – P. 401–409. http://doi.org/10.1111/1471-0528.16318.
18. De Bernardo G., De Santis R., Giordano M. et al. Predict respiratory distress syndrome by umbilical cord blood gas analysis in newborns with reassuring Apgar score // Ital J Pediatr. – 2020. – Vol. 46, № 1. – P. 20. http://doi.org/10.1186/s13052-020-0786-8.
19. D’Antonio F., Marinceu D., Prasad S. et al. Outcome following laser surgery of twin-twin transfusion syndrome complicated by selective fetal growth restriction: systematic review and meta-analysis // Ultrasound Obstet Gynecol. – 2023. – Vol. 62, № 3. – P. 320–327. http://doi.org/10.1002/uog.26252.
20. El Emrani S., Groene S. G., Verweij E. J. et al. Gestational age at birth and outcome in monochorionic twins with different types of selective fetal growth restriction: A systematic literature review // Prenat Diagn. – 2022. – Vol. 42, № 9. – P. 1094–1110. http://doi.org/10.1002/pd.6206.
21. Fleiss N., Coggins S. A., Lewis A. N. et al. Evaluation of the neonatal sequential organ failure assessment and mortality risk in preterm infants with late-onset infection // JAMA Netw Open. – 2021. – Vol. 4, № 2. – P. e2036518. http://doi.org/10.1001/jamanetworkopen.2020.36518.
22. Gijtenbeek M., Shirzada M. R., Ten Harkel A. D. J. et al. Congenital heart defects in monochorionic twins: a systematic review and meta-analysis // J Clin Med. – 2019. – Vol. 8, № 6. – P. 902. http://doi.org/10.3390/jcm8060902.
23. Giorgione V., D’antonio F., Manji A. et al. Perinatal outcome of pregnancy complicated by twin anemia-polycythemia sequence: systematic review and meta-analysis // Ultrasound Obstet Gynecol. – 2021. – Vol. 58, № 6. – P. 813–823. http://doi.org/10.1002/uog.23585.
24. Gratacós E., Lewi L., Muñoz B. et al. A classification system for selective intrauterine growth restriction in monochorionic pregnancies according to umbilical artery Doppler flow in the smaller twin // Ultrasound Obstet Gynecol. – 2007. – Vol. 30, № 1. – P. 28–34. http://doi.org/10.1002/uog.4046.
25. Groene S. G., de Vries L. S., Slaghekke F. et al. Changes in structural brain development after selective fetal growth restriction in monochorionic twins // Ultrasound Obstet Gynecol. – 2022. – Vol. 59, № 6. – P. 747–755. http://doi.org/10.1002/uog.24832.
26. Ishii K., Murakoshi T., Takahashi Y. et al. Perinatal outcome of monochorionic twins with selective intrauterine growth restriction and different types of umbilical artery Doppler under expectant management // Fetal Diagn Ther. – 2009. – Vol. 26, № 3. – P. 157–161. http://doi.org/10.1159/000253880.
27. Jordan B. K., Bernard L., Segel S. et al. Premature monochorionic monoamniotic twins have lower lung compliance at birth than matched dichorionic diamniotic twins // J Neonatal Perinatal Med. – 2023. – Vol. 16, № 1. – P. 87–92. http://doi.org/10.3233/NPM-221113.
28. Kikuchi H., Noda S., Katsuragi S. et al. Evaluation of 3-tier and 5-tier FHR pattern classifications using umbilical blood pH and base excess at delivery // PLoS One. – 2020. – Vol. 15, № 2. – P. 0228630. http://doi.org/10.1371/journal.pone.0228630.
29. Kilby M. D., Bricker L. Royal College of Obstetricians and Gynaecologists. Management of monochorionic twin pregnancy green-top guideline No. 51 (2024 Partial Update) // BJOG. – 2025. – Vol. 132, № 6. – P. e98–e129. http://doi.org/10.1111/1471-0528.18055.
30. Kurul S., Simons S. H. P., Ramakers C. R. B. et al. Association of inflammatory biomarkers with subsequent clinical course in suspected late onset sepsis in preterm neonates // Crit Care. – 2021. – Vol. 25, № 1. – P. 12. http://doi.org/10.1186/s13054-020-03423-2.
31. Lim S. Y., Shin S. H., Yang H. J. et al. Neonatal and developmental outcomes of very preterm twins according to the chorionicity and weight discordance // Sci Rep. – 2023. – Vol. 13, № 1. – P. 6784. http://doi.org/10.1038/s41598-023-33428-0.
32. Magawa S., Nii M., Tanaka H. et al. Phase-1 clinical study of tadalafil administered for selective fetal growth restriction in twin pregnancy // J Matern Fetal Neonatal Med. – 2021. – Vol. 34, № 7. – P. 1075–1082. http://doi.org/10.1080/14767058.2019.1624717.
33. Meert K. L., Banks R., Holubkov R. et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Morbidity and mortality in critically ill children. II. A Qualitative patient-level analysis of pathophysiologies and potential therapeutic solutions // Crit Care Med. – 2020. – Vol. 48, № 6. – P. 799–807. http://doi.org/10.1097/CCM.0000000000004332.
34. Menon K., Schlapbach L.J., Akech S. et al. Pediatric sepsis definitiona systematic review protocol by the Pediatric Sepsis Definition Taskforce // Crit Care Explor. – 2020. – Vol. 2, № 6. – P. e0123. http://doi.org/10.1097/CCE.0000000000000123.
35. Mustafa H. J., Aghajani F., Patrick E. et al. Perinatal outcomes following fetoscopic laser surgery for early twin-to-twin transfusion syndrome: Systematic review and meta-analysis // Acta Obstet Gynecol Scand. – 2024. – Vol. 103, № 5. – P. 824–831. http://doi.org/10.1111/aogs.14806.
36. Noll A. T. R., Gijtenbeek M., Verweij E. J. T. J. et al. Cardiac adaptation and malformation in twin-twin transfusion syndrome and selective fetal growth restriction: A systematic review // Prenat Diagn. – 2024. – Vol. 44, № 6–7. – P. 832–845. http://doi.org/10.1002/pd.6575.
37. Ostrander B., Bale J. F. Congenital and perinatal infections // Handb Clin Neurol. – 2019. – № 162. – P. 133–153. http://doi.org/10.1016/B978-0-444-64029-1.00006-0.
38. Procianoy R. S., Silveira R. C. The challenges of neonatal sepsis management // J Pediatr (Rio J). – 2020. – Vol. 96, № 1. – P. 80–86. http://doi.org/10.1016/j.jped.2019.10.004.
39. Robinson A., Teoh M., Edwards A. et al. Fetal brain injury in complicated monochorionic pregnancies: diagnostic yield of prenatal MRI following surveillance ultrasound and influence on prognostic counselling // Prenat Diagn. – 2017. – Vol. 37, № 6. – P. 611–627. http://doi.org/10.1002/pd.5059.
40. Rosen H., Silber R., Schwartz A. et al. Fetal and neonatal brain injury in twins complicated by twin anemia polycythemia sequence // Prenat Diagn. – 2022. – Vol. 42, № 8. – P. 978–984. http://doi.org/10.1002/pd.6194.
41. Slaghekke F., Kist W. J., Oepkes D. et al. Twin anemia-polycythemia sequence: diagnostic criteria, classification, perinatal management and outcome // Fetal Diagn Ther. – 2010. – Vol. 27, № 4. – P. 181–190. http://doi.org/10.1159/000304512.
42. Spruijt M. S., Lopriore E., Steggerda S. et al. Twin-twin transfusion syndrome in the era of fetoscopic laser surgery: antenatal management, neonatal outcome and beyond // Expert Rev Hematol. – 2020. – Vol. 13, № 3. – P. 259–267. http://doi.org/10.1080/17474086.2020.1720643.
43. Spruijt M. S., van Klink J. M. M., de Vries L. S. et al. Fetal and neonatal neuroimaging in twin-twin transfusion syndrome // Ultrasound Obstet Gynecol. – 2024. – Vol. 63, № 6. – P. 746–757. http://doi.org/10.1002/uog.27583.
44. Thangatorai R., Lim F. C., Nalliah S. Cervical pessary in the prevention of preterm births in multiple pregnancies with a short cervix: PRISMA compliant systematic review and metaanalysis // J Matern Fetal Neonatal Med. – 2018. – Vol. 31, № 12. – P. 1638–1645. http://doi.org/10.1080/14767058.2017.1319930.
45. Tollenaar L. S. A., Slaghekke F., Lewi L. et al. Spontaneous twin anemia polycythemia sequence: diagnosis, management, and outcome in an international cohort of 249 cases // Am J Obstet Gynecol. – 2021. – Vol. 224, № 2. – P. 213.e1–213.e11. http://doi.org/10.1016/j.ajog.2020.07.041.
46. Watson R. S., Crow S. S., Hartman M. E. et al. Epidemiology and outcomes of pediatric multiple organ dysfunction syndrome // Pediatr Crit Care Med. – 2017. – Vol. 18, № 3, Suppl 1. – P. S4–S16. http://doi.org/10.1097/PCC.0000000000001047.
47. Wee L. Y., Taylor M. J., Vanderheyden T. et al. Transmitted arterio-arterial anastomosis waveforms causing cyclically intermittent absent/reversed end-diastolic umbilical artery flow in monochorionic twins // Placenta. – 2003. – № 24. – P. 772–778. http://doi.org/10.1016/s0143-4004(03)00114-0.
48. Weiss S. L., Peters M. J., Alhazzani W. et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children // Intensive Care Med. – 2020. – Vol. 46, Suppl 1. – P. 10–67. http://doi.org/10.1007/s00134-019-05878-6.
49. Wynn J. L., Polin R. A. A neonatal sequential organ failure assessment score predicts mortality to late-onset sepsis in preterm very low birth weight infants // Pediatr Res. – 2020. – Vol. 88, № 1. – P. 85–90. http://doi.org/10.1038/s41390-019-0517-2.
Review
For citations:
Davydenko A.I., Kinzhalova S.V., Zakharova S.Yu., Makarov R.A., Pavlichenko M.V. Multiple organ failure syndrome in the neonatal period in preterm newborns from monochorionic twins (literature review). Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2026;23(1):129-136. (In Russ.) https://doi.org/10.24884/2078-5658-2026-23-1-128-135
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