Premature monochorionic monoamniotic twins have lower lung compliance at birth than matched dichorionic diamniotic twins.
Premature monochorionic monoamniotic twins have lower lung compliance at birth than matched dichorionic diamniotic twins.
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DOI：
10.3233/npm-221113
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发表时间：
2023
影响因子：
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通讯作者：
McEvoy, Cindy T
中科院分区：
文献类型：
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作者：
Jordan, Brian K;Bernard, Leah;Segel, Sally;Go, Mitzi D;Schilling, Diane;McEvoy, Cindy T
早产儿出生时肺发育不成熟，表现出肺功能异常，在被动呼吸系统顺应性和抵抗性以及功能残余容量方面存在差异。据我们所知，尚无研究评估基于双胎妊娠类型或绒毛膜性的新生儿肺功能差异。鉴于绒毛膜性对预后的影响，我们旨在研究双胞胎类型，单绒毛膜单羊膜（MCMA）与双绒毛膜双羊膜（DCDA）对新生儿早期肺功能检查的影响。在这项前瞻性队列研究中，5对DCDA双胞胎与5对MCMA双胞胎在分娩时的胎龄、产前皮质类固醇暴露潜伏期、出生体重、种族和性别方面进行了匹配。比较被动呼吸系统顺应性和阻力、功能剩余容量和潮气量的平均值。MCMA婴儿的依从性显著低于DCDA婴儿（0.64 vs 1.25mL/cm H2O /kg, p = 0.0001），而耐药性显著高于DCDA婴儿（0.130 vs 0.087 cm H2O /mL/sec, p = 0.0003）。MCMA婴儿的功能剩余容量低于DCDA婴儿（17.5 ml /kg vs 23.4mL/kg; p = 0.17）。此外，80%的MCMA婴儿需要插管给药表面活性剂，而20%的DCDA婴儿需要插管给药，这表明这些客观测量的临床意义。由于配对病例对照设计，无法确定因果关系。然而，我们推测，这些肺功能的差异可能源于不同的暴露于早产和内源性母体皮质类固醇暴露。要建立真正的因果关系，还需要进一步的研究。
Premature infants are born with immature lungs that demonstrate abnormal pulmonary function with differences in passive respiratory system compliance and resistance, and functional residual capacity. To our knowledge, no studies have evaluated differences in neonatal pulmonary function based on the type of twin gestation, or chorionicity. Given the effect of chorionicity on outcomes, we aimed to study the effect of twin type, monochorionic monoamniotic (MCMA) vs dichorionic diamniotic (DCDA), on neonatal early pulmonary function tests. In this prospective cohort study, 5 sets of DCDA twins were matched to 5 sets of MCMA twins on gestational age at delivery, latency from antenatal corticosteroid exposure, birthweight, race and gender. Mean values were compared for passive respiratory system compliance and resistance, functional residual capacity, and tidal volume. MCMA infants had a significantly lower compliance (0.64 vs 1.25mL/cm H2O /kg; p = 0.0001) and significantly higher resistance (0.130 vs 0.087 cm H2O /mL/sec; p = 0.0003) than DCDA infants. Functional residual capacity was lower for MCMA than DCDA infants (17.5 vs 23.4mL/kg; p = 0.17). Further, 80% of MCMA infants required intubation for surfactant administration compared to 20% of DCDA infants, indicating the clinical significance of these objective measures. Due to the matched case-control design, causality cannot be established. However, we speculate that these differences in lung function may derive from differential exposure to preterm labor and endogenous maternal corticosteroid exposure. Further study is necessary to establish the true causal relationship.