Acute and chronic fetofetal transfusion syndrome

In the fetofetal transfusion syndrome we can discriminate between a chronic form with severe difference in weight and an acute form with a difference in haemoglobin between the twins. The aim of the retrospective study was to investigate the influence of both forms regarding infant morbidity and mortality. Of the 135 twins treated from 1.1.1984 to 31.12.1993 in the Department of Pediatrics at the Christian-Albrechts-University Kiel, 27 (20%) showed evidence of fetofetal transfusion. Twelve (8.8%) fulfilled the criteria for an acute and 10 (7.4%) for a chronic transfusion. In 5 (3.9%) twins both forms were evident. Clear differences between twins with acute or chronic fetofetal transfusion syndrome could be seen in gestational age and birth weight. The twins with an acute fetofetal transfusion were significantly older (median: 31.5 vs. 29.0 weeks of gestation), and heavier (median: 1900 vs. 1020 g). Furthermore this group faired significantly better statistically when compared to the chronic form as regards the incidence of mortality (7 vs. 0), the Respiratory Distress Syndrome grades III and IV (7 vs. 2), persistent ductus arteriosus (13 vs 9), intraventricular haemorrhage (14 vs 6) and posthaemorrhagic hydrocephalus (4 vs 0). Similar significant differences could be seen as regards mortality, the Respiratory Distress Syndrome, and intraventricular haemorrhage when acute fetofetal transfusion was compared with the combined acute on chronic form. No significant difference regarding neonatal morbidity and mortality, however, could be shown between infants having undergone chronic fetofetal transfusion and infants with the combined acute on chronic form. It can be concluded that twins with chronic fetofetal transfusion show a higher rate of neonatal morbidity and mortality, whereas, the acute form does not significantly influence these factors. As both forms not only differ in onset of the disease, pathogenesis, and the actual course of the disease. It is important to always differentiate between the acute and chronic forms.