Introduction: Altered hemodynamics associated with twin to twin transfusion syndrome (TTTS) can be manifested in the heart. This study evaluated the association between cardiac manifestations immediately after birth and brain injury in preterm infants with TTTS.
Methods: Medical records of preterm infants who were born at < 35 weeks of gestation with TTTS and admitted to the neonatal intensive care unit at Seoul National University Children’s Hospital between January 2011 and January 2018 were reviewed. TTTS was prenatally diagnosed and staged according to the Quintero criteria. Echocardiographic findings and brain ultrasound and MRI imaging findings were analyzed.
Results: Fifty-three infants were enrolled in this study. Six (11.3%) infants were stage I, 2 (3.8%) were stage II, 20 (39.6%) were stage III, 16 (30.2%) were stage IV and 8 (15.1%) were stage V. Thirty-two infants (60.3%) were treated by fetoscopic laser coagulation. Brain injury developed in 15 infants (28.3%). The univariate logistic regression analysis showed that postnatal hypotension, cardiac manifestations (such as ventricular dysfunction) and significant tricuspid regurgitation (>3 m/s) were associated with brain injury. In the multivariate analysis, acute kidney injury (OR 18.7 95% CI 1.9-205.1), ventricular dysfunction (OR 18.1, 95% CI 2.2-148.1) and significant tricuspid regurgitation (OR 9.7, 95% CI 1.2-79.3) were statistically associated with brain injury in the study population.
Conclusion: Immediate postnatal cardiac manifestations, such as ventricular dysfunction and tricuspid regurgitation, can serve as surrogate markers for perinatal hemodynamics, which are associated with early neonatal brain injury in preterm infants with TTTS.

EARLY POSTNATAL CARDIAC MANIFESTATIONS WERE ASSOCIATED WITH PERINATAL BRAIN INJURY OF PRETERM INFANTS WITH TWIN TO TWIN TRANSFUSION SYNDROME