Hasan Tolga ÇELİK, M. Sinan BEKSAC, Melek BÜYÜKEREN, Murat YURDAKÖK, Erdem FADIOĞLU, Umut Ece ARSLAN, Şule YİĞİT, Işıl BİLGİÇ

A comparison of inflammatory indicators in twins on the first postnatal day

Aim: To investigate markers of sepsis/inflammation in twin neonates according to placental, demographic, neonatal, and twin-related complications. Materials and Methods: In this retrospective study, we compared these parameters in twins with suspected sepsis for whom laboratory data on infection markers were available on the first postnatal day. Sepsis was later ruled out in all the neonates. After obtaining institutional ethics committee approval, twin pairs who were admitted to the neonatal intensive care unit of Hacettepe University IhsanDogramacı Children's Hospital between 2005 and 2017 were screened for inclusion. Data on the twins’ sepsis markers, complete blood counts, immature to total neutrophil (I/T) ratios, procalcitonin and CRP levels, and blood culture results in the first 24 h of life were recorded.Results: In total, 194 twin pairs (388 neonates) were included in the study. Of the 194 twin pairs, 50 were monochorionic twins (25.8 %), and the remaining 144 (74.2 %) were dichorionic twins. Monochorionic and dichorionic twins, twin-to-twin transfusion syndrome with twins and discordant twins showed no significant differences in I/T ratio, procalcitonin, or CRP values in the first 24 h (p>0.05).Conclusion: Based on our findings, chorionicity (monochorionic/dichorionic placenta), twin-to-twin transfusion syndrome, and size discordance were not related to any significant differences in the CRP level, procalcitonin level, or I/T ratio.

PDF

___

1. Kulkarni AD, Kissin DM, Adashi EY. Fertility treatments and multiple births in the United States. N Eng J Med 2014;370:1070-1.
2. Martin JA, Hamilton BE, Osterman MJ, et al. Births: final data for 2013. Natl Vital Stat Rep 2015;64:1-65.
3. Mandy GT. Neonatal complications, outcome, and management of multiple births. UpToDatewww. uptodate.com (24 October 2017).
4. Quintero RA, Morales WJ, Allen MH, et al. Staging of twin-twin transfusion syndrome. J Perinatol 1999;19:550-5.
5. Bermúdez C, Becerra CH, Bornick PW, et al. Placental types and twin twin transfusion syndrome. Am J Obstet Gynecol 2002;187:489-94.
6. Chauhan N, Tiwari S, Jain U. Potential biomarkers for effective screening of neonatal sepsis infections: An overview. Microb Pathog 2017;107:234-42.
7. Hedegaard SS, Wisborg K, Hvas AM. Diagnostic utility of biomarkers for neonatal sepsis--a systematic review. Infect Dis (Lond) 2015;47:117-24.
8. Tang BM, Eslick GD, Craig JC, et al. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis 2007;7:210-7.
9. Leombroni M, Liberati M, Fanfani F, et al. Diagnostic accuracy of ultrasound in predicting birth-weight discordance in twin pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2017;50:442-50.
10. Chiesa C, Natale F, Pascone R, et a,l. C reactive protein and procalcitonin: reference intervals for preterm and term newborns during the early neonatal period. Clin Chim Acta 2011;412:1053-9.
11. Fendler WM, Piotrowski AJ. Procalcitonin in the early diagnosis of nosocomial sepsis in preterm neonates. J Paediatr Child Health 2008;44:114-8.
12. Murphy K, Weiner J. Use of leukocyte counts in evaluation of early-onset neonatal sepsis. Pediatr Infect Dis J 2012;31:16-9.
13. Hamilton BE, Martin JA, Osterman MJ, et al. Births: Final Data for 2014. Natl Vital Stat Rep 2015;64:1-64.
14. Chaudhary S, Singh RR, Shah GS, et al. Outcome of Twin Deliveries at a Tertiary Care Centre of Eastern Nepal. J Nepal Health Res Counc 2016;14:128-31.
15. Ribicic R, Kranjcec I, Borosak J, et al. Perinatal outcome of singleton versus twin late preterm infants: do twins mature faster than singletons? J Matern Fetal Neonatal Med 2016;29:1520-4.
16. Cheong-See F, Schuit E, Arroyo-Manzano D, et al. Global Obstetrics Network (GONet) Collaboration. Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis. BMJ 2016;354:i4353.
17. Martin JA, Hamilton BE, Osterman MJ, et al. Births: final data for 2013. Natl Vital Stat Rep 2015;64:1-65.
18. Mandy GT. Neonatal complications, outcome, and management of multiple births. UpToDatewww. uptodate.com (24 October 2017).
19. Verbeek L, Slaghekke F, Sueters M, et al. Hematological disorders at birth in complicated monochorionic twins. Expert Rev Hematol 2017;10:525-32.
20. Wenstrom KD, Tessen JA, Zlatnik FJ, et al. Frequency, Distribution, and Theoretical Mechanisms of Hematologic and Weight Discordance in Monochorionic Twins. Obstet Gynecol 1992;80:257- 61.
21. Mabuchi A, Ishii K, Yamamoto r, et al. Clinical Characteristics of Monochorionic Twins with Large Hemoglobin Level Discordance at Birth. Ultrasound Obstet Gynecol 2014;44:311-5.
22. Bellieni CV, Liuzzo LP, Giomi S, et al. C-reactive protein: a marker of neonatal stress? J Matern Fetal Neonatal Med 2014;27:612-5.
23. Stocker M, Hop WC, van Rossum AM. Neonatal Procalcitonin Intervention Study (NeoPInS): Effect of Procalcitonin-guided decision making on duration of antibiotic therapy in suspected neonatal earlyonset sepsis: a multi-centre randomized superiority and non-inferiority Intervention Study BMC Pediatr 2010;10:89.
24. Lee J, Bang YH, Lee EH, et al. The influencing factors on procalcitonin values in newborns with noninfectious conditions during the first week of life. Korean J Pediatr 2017;60:10-6.
25. Perrone S, Lotti F, Longini M, et al. C reactive protein in healthy term newborns during the first 48 hours of life. Arch Dis Child Fetal Neonatal Ed 2018;103:F163-6.
26. Yao A, Liu J, Chang J, et al. Clinical practice of procalcitonin and hypersensitive C-reactive protein test in neonatal infection. Pak J Pharm Sci 2016;29:753-6.
27. Krasteva M, Karastaneva A, Besheva M , et al. [Dynamics in levels of procalcitonin in healthy term newborns duringthefirst 24 hours of life]. Akush Ginekol (Sofiia). 2013;52:23-8.