Liveborn twin with intrauterine death of one twin: report of two cases

Twin pregnancies carry a greater mortality and morbidity rate than singleton pregnancies. In case of an intrauterine fetal death (IUFD), the risk of mortality and morbidity of the surviving twin is increased. The pathogenesis is usually due to twin to twin transfusion. The donor twin is hypovolemic, anemic and often shows a growth retardation or even severe enough to cause an IUFD. The recipient twin is hypervolemic, polycythemic and weighs more than its co-twin. In this paper we reported two cases of liveborn twin complicated by an IUFD of its co-twin. Both cases were monochorionic twins. The first case was born at 29 weeks and 6 days of gestation, a male infant weighed 1054 g. His co-twin was stillborn and weighed 722 g. At birth the surviving infant showed respiratory distress syndrome (RDS), anemia and bilateral periventricular echogenicity (PVE). The second case was a female infant with a gestational age of 26 weeks and 2 days and weighed 850 g. Her stillborn co-twin weighed 804 g. Both twins showed signs of hydrops, and the liveborn infant had RDS, marked anemia (Hb 6 g/dl) and hypoalbuminemia. We will discuss the possible pathogenesis in our cases and also review some literature.     

A cotwin control study and a twin study of reflection-impulsivity in children.

Examined the modifiability and heritability of reflection-impulsivity as measured by Matching Familiar Figures. A co-twin control study of 3 pairs of 4-yr-old identical twins was conducted to study the modifiability of the trait. The heritability of the trait was investigated by a twin study of 54 pairs of 3- to 6-yr-old twins. The co-twin study suggests little modifiability of reflection-impulsivity, and the twin study suggests that some of the resistance to change may be due to genetic factors. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A twin study of cognitive function in chronic fatigue syndrome: The effects of sudden illness onset.

Variable reports of neuropsychological deficits in individuals with chronic fatigue syndrome (CFS) may, in part, be attributable to methodological limitations. In this study, these limitations were addressed by controlling for genetic and environmental influences and by assessing the effects of comorbid depression and mode of illness onset. Specifically, the researchers conducted a co-twin control study of 22 pairs of monozygotic twins, in which 1 twin met strict criteria for CFS and the co-twin was healthy. Twins underwent a structured psychiatric interview and comprehensive neuropsychological assessment evaluating 6 cognitive domains. Results indicated that twin groups had similar intellectual and visual memory functioning, but fatigued twins exhibited decreases in motor functions (p = .05), speed of information processing (p = .02), verbal memory (p = .02), and executive functioning (p = .01). Major depression did not affect neuropsychological functioning among fatigued twins, although twins with sudden illness onset demonstrated slowed information processing compared with those with gradual onset (p = .01). Sudden onset CFS was associated with reduced speed of information processing. If confirmed, these findings suggest the need to distinguish illness onset in future CFS studies and may have implications for treatment, cognitive rehabilitation, and disability determination. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief Maternal Interaction Increases Number, Amplitude, and Bout Size of Isolation-Induced Ultrasonic Vocalizations in Infant Rats (Rattus norvegicus).

The number, amplitude, duration, and bout structure of isolation-induced ultrasonic vocalization (USV) of infant rats (Rattus norvegicus) were measured on postnatal Day 10. Measurements were made before and after a brief, 1-min, active interaction with their mother or before and after a "pick-up" control procedure. Consistent with prior studies, the number of USVs emitted was significantly increased in the period following the maternal reunion but not after the control procedure. The average amplitude of USVs was also greater following maternal reunion. Finally, analyses characterizing the bout structure of USV production indicated that the average bout size (i.e.. number of USVs/bout) was increased severalfold following the reunion with the mother, accounting for the greater rate of USV production during the second isolation period. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prognosis and long-term follow-up of a twin after antenatal death of the co-twin

It is generally believed that among twin pregnancies with one fetal loss prior to delivery, the surviving twin has an increased rate of perinatal mortality and childhood morbidity (cerebral palsy and mental retardation). By using data from the National Medical Birth Registry of Sweden between 1973 and 1983, we identified 206 gestations with the death of at least one twin (in 36 pregnancies both twins died) prior to delivery. The original medical records were retrieved for study. The presence of childhood morbidity for 65 of 129 surviving (8 years of age or older) twins born between 1973 and 1980 was evaluated by a questionnaire sent to rehabilitation centers for disabled children, as well as to offices for the Provision of Care for the Mentally Retarded. Perinatal mortality for a twin after the antenatal death of the co-twin was considerable. Fifty percent of survivors died before 34 weeks' gestation, and 18.7% thereafter. At follow-up, 8 years or more after birth, three twins (4.6%) were handicapped. Our results indicate the need for careful monitoring of the surviving twin fetus after one twin has succumbed prenatally.     

To be born as a twin--risks and sequelae

About 2.5% of infants born in Finland are twins. Twins have long been objects for genetic studies, which nowadays have large study groups, e.g. twin registers from a whole country. Twins can also be studied from another point of view: the special situation of being a twin, and its consequences on development and mental health. Perinatal mortality and morbidity are higher in twins than in singletons, and accordingly cumulative incidences of various handicaps are higher in twins. The human relationships of twins have their special features from the early beginning. Twins have to share the attention from the parents, and some parents resolve the situation by sharing the twins: "mother's child" and "father's child" may develop. Twins may be dependent on each other, and the inter-twin relationship can also be characterized by dominance-submissiveness. In adolescence, the time of getting independence from the parents, twins have also another task of development: they have to grow up from the co-twin dependence in order to become autonomous adults. In comparison to much bigger twin materials of genetic studies, follow-up studies in birth cohorts have their benefits, too. They give us a good opportunity to research the development of human relationships in twin families and their consequences on both somatic and mental health.     

Differential effects of perinatal hypoxic risk on early developmental outcome: A twin study.

The goal of this twin study was to explore the effects of perinatal neurobiological risk on 2 dimensions of early developmental outcome: mental and motor. The hypothesis was that the performance of the twin considered to be at higher risk for hypoxic insult would fall short of that exhibited by the lower risk co-twin. Twin discordance was established on 2 indirect indices of perinatal hypoxic risk: the Apgar score and the degree of need for neonatal respiratory oxygen support. The early outcome measures, the Bayley Scales of Infant Development (BSID), mental (MDI) and psychomotor (PDI) components, were obtained for 76 infants. Fifty-six infants were from 28 pairs of twins who were determined to be discordant, and 20 infants from 10 additional pairs who were found to be nondiscordant, on the risk indices. Although the average differences between the discordant co-twins in Apgar scores and in need for oxygen supplementation were small, the twins who were at higher risk for hypoxic insult had a significantly lower MDI compared to their lower risk co-twins. This within-pair effect was somewhat greater for premature, same-sex twins. No intrapair differences associated with risk level were found on the PDI.… (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parent-Infant Synchrony and the Social-Emotional Development of Triplets.

To study the social-emotional development of triplets, 23 sets of triplets, 23 sets of twins, and 23 singleton infants (N=138) were followed from birth to 2 years. Maternal depression and social support were assessed in the postpartum period, mother-infant and father-infant interaction and the home environment were observed at 3 months, a separation-reunion episode and a maternal interview were conducted at 12 months, and infant behavior problems were evaluated at 24 months. Lower parent-infant synchrony was observed for triplets. Triplets showed less distress during maternal separation and less approach at reunion. Mothers reported lower adjustment and differentiation among siblings for triplets than for twins. Higher internalizing problems were reported for triplets, and the triplet with intrauterine growth retardation showed the poorest outcomes. Behavior problems were predicted by medical risk, maternal depression, parent-infant synchrony, infant approach, and mother adjustment. Discussion focuses on developmental risk when the exclusivity of the parent-infant relationship is compromised. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neonatal Basedow's disease in twins from a mother with severe T3 hyperthyroidism

HISTORY AND CLINICAL FINDINGS: Dizygotic twin sisters were born to a woman who, shortly before becoming pregnant, had developed Graves' disease with markedly elevated triiodothyronine (T3) levels and highly positive TSH receptor antibody titres (TRAb: 169 mU/ml). From the second week of life onwards they had a goitre and hyperexcitability, tachycardia and failure to thrive were noted. In addition, twin I had mild exophthalmos. As thyrostatic treatment of the mother was very difficult, intrauterine hypothyroidism or transitory hyperthyroidism had presumably occurred in the twins. INVESTIGATIONS: Twin I had maximal thyroxine (T4) concentration of 26.2 micrograms/dl, while it was 24.7 micrograms/dl in twin II with suppressed TSH. Both twins had high concentrations of TRAb and antibodies against thyroid peroxidase. DIAGNOSIS, TREATMENT AND COURSE: With the diagnosis of neonatal Graves' disease established, both twins were treated with propranolol (2 mg/kg.d) and phenobarbitone (2-4 mg/kg.d). Twin I, whose symptoms were more severe, also received propylthiouracil (5 mg/kg.d) until euthyroidism had been achieved. Although twin II became euthyroid spontaneously, she gained weight only slowly and microcephaly developed together with definite motor and mental retardation. It remains unclear whether these were consequences of intrauterine hypothyroidism or post-partum hyperthyroidism. CONCLUSION: Graves' disease during pregnancy demands interdisciplinary collaboration between gynaecologist, physician and paediatrician to prevent severe sequelae in the children. Early risk assessment is possible by measuring the TSH receptor antibody titre in umbilical blood.     

Age-mate or twin sibling: Effects on monkey age-mate interactions during infancy.

12 rhesus monkey infants were reared with a mother and nonsibling peers; 8 had an age-mate or twin sibling, while 4 control infants did not. The twin sibling relationship was produced experimentally by pairing infants at birth and fostering them 2 to a mother; the control infants were also paired but fostered 1 to a mother. Positive affiliation with the paired rearing partner began earlier in the twin group and continued at higher levels throughout a 7-mo period of observation. The twins also engaged in more positive affiliation with age-mates other than the rearing partner, while the control infants more frequently engaged in solitary activities and displayed more aggressive and submissive behavior. It is concluded that the age-mate sibling had a beneficial effect upon early social development. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age-mate or twin sibling: Effects on interactions between monkey mothers and infants.

Examined the effects of the twin sibling relationship upon interactions between mother and infant. 12 rhesus monkey infants were reared with a mother and nonsibling peers; 8 had an age-mate or twin sibling, while 4 control infants did not. The sibling pairs were formed by fostering newborns 2 to a mother; the control infants were fostered 1 to a mother. Findings indicate that the twin infants did not engage in as much interaction with their mothers throughout a 7-mo period of observation on a wide range of indexes, including such basic behaviors as a contact with the mother's ventrum and nipples. The mothers rearing twins spent less time cradling their infants and less frequently rejected them. There were a few additional differences, notably in the area of restrictive behavior, but it is concluded that the differences in maternal behavior were principally a reaction to the differences in infant behavior. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Synergistic interaction of 3 M KCl-extracted donor antigens (e-HAg) with cyclosporine or cyclosporine/sirolimus for prolongation of rat heart allograft survival

This article examines the attaching and detaching experience of a mother encountering the perinatal death of a twin. Her experience is related to the relevant theoretical and research literature pertaining to prebirth and postbirth maternal-infant attachment and detachment (grieving). Literature for both single infants and twins is considered. The experience of this mother suggests that elements of postbirth attachment may have been accelerated into the prebirth period. In addition, her postbirth attaching and detaching experience suggests that an attachment and detachment to the twins as a unit preceded detachment from the twin who died. The health care provider's role in promoting maternal well-being, and indirectly the well-being of the surviving infant, is described.     

Evidence for genetic influences on personality from self-reports and informant ratings.

Self-report data on Extraversion (E) and Neuroticism (N), together with ratings by the co-twin, were obtained from a sample of 826 adult female twin pairs ascertained through a population-based twin register. Data were analyzed using a model that allowed for the contributions to personality ratings of the rater's personality (rater bias) as well as of the personality of the person being rated. For E, but not for N, significant rater bias was found, with extraverted respondents tending to underestimate, and introverted respondents tending to overestimate, the E of their co-twins. Good agreement between self-reports and ratings by the respondent's co-twin was found for both E and N. Substantial genetic influences were found for both personality traits, confirming findings from genetic studies of personality that have relied only on self-reports of respondents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eight-year follow-up of cognitive development in 33 twin pairs

This is a follow-up study of twins, including 33 twinpairs from the Stockholm area, aiming to study the cognitive development of twins at eight years of age. The twins have been followed at different ages from birth onwards. All children were tested with the Wechsler Intelligence Scale for Children in a Swedish translation (WISC). The WISC test consists of a Verbal and a Performance Scale. There were no significant differences between twin girls and twin boys on these Scales. On the Performance subtests Block Design, Object Assembly, and Coding, however, the twin girls performed significantly better than the twin boys. In comparing cognitive development for twins and singletons, the twin group had somewhat lower average scores than the singletons. Prematurity and low birth weight continued to be related to cognitive development at eight years of age. Also at this age the school teacher completed a questionnaire about the twins social behaviour and some personality traits. There was a relation between one questionnaire factor, a low score of assertiveness, and the mother's negative or ambivalent expectations concerning the twin pregnancy. The twin group with the mother's negative expectations also had significantly lower results on the subtests Comprehension and Coding. Negative mothers had more premature twins than mothers who were positive toward the twin pregnancy.     

A microscopic analysis of cut-bevel versus pencil-point spinal needles

OBJECTIVE: Our purpose was to establish new nomograms for the birth weight of twins on the basis of accurate methods to validate gestational age. STUDY DESIGN: The medical records of 1632 consecutive twin gestations delivered between 1984 and 1996 were reviewed. Only pregnancies induced by ovulation induction techniques or that were measured ultrasonographically for crown-rump length during the first trimester were included. Excluded were those whose fetuses (one or both) were stillborn, or if the mother smoked, had a significant chronic illness, or was prescribed any regular medications. The study comprised 520 twin pregnancies at 28 to 41 gestational weeks at delivery. RESULTS: The median and 10th and 90th percentile birth weight curves were calculated for the studied twins and plotted against previously reported singleton nomograms. Fetuses of twin pregnancies were found to be growth restricted in comparison with previously reported singletons throughout the third trimester. This trend became more evident after the thirty-fourth to thirty-sixth weeks. CONCLUSIONS: We recommend these novel birth weight nomograms for clinical use in the management of twin pregnancies.     

The individualization of care practices for twins during the first year

BACKGROUND: Mothers of twins have some difficulties to individualize their child-raising activities during the first year. This study was aimed to determine factors influencing such activities. POPULATION AND METHODS: Thirty-seven pairs of twins born after 36 weeks of gestation and weighing more than 2,000 g were included in the study. Relationships between the parents and their children were studied from questionnaires concerning activities during the first trimester and the end of the first year of age. Each item concerning organization of meals and sleeping was graded 1 to 3 according to the degree of individualization of the care. Items concerning support of the mother by the father or other people were graded 1 to 3 according to the degree of this assistance. The physical and psychological status of the mother was also graded according to the presence or not of asthenia and/or depression. Home activities of the mother were also observed. RESULTS: The state of the mother during the first few months had an impact on her mothering behavior: tired or depressed mothers tend to treat the twins collectively and simultaneously. No link was found between social, paternal or general familial support and the degree of individualization in the maternal behaviors. CONCLUSIONS: Several factors can interfere with the psychological repercussions of a twin birth on the mother and subsequent psychoemotional development of children. Further studies are necessary to understand how each parent contributes to the organization of the family system.     

Safety of oral propafenone in the treatment of arrhythmias in infants and children (European retrospective multicenter study). Working Group on Pediatric Arrhythmias and Electrophysiology of the Association of European Pediatric Cardiologists

BACKGROUND: During twin pregnancies, several complications may result in the death of a co-twin depending on the date of death. We describe herein 2 infant survivors of monozygotic twin pairs with 2 distinct possible complications: a aplasia cutis congenita and Volkmann ischemic contracture. OBSERVATIONS: One infant had extensive aplasia cutis congenita with an associated monozygotic co-twin who died at 3 months of gestation, and the other child had a localized arm defect due to Volkmann ischemic contracture and brain damage, with a co-twin who died at approximately 6 weeks of gestation. CONCLUSIONS: Congenital cutaneous defects may result in the death of a co-twin. The most common of these defects is aplasia cutis congenita associated with a fetus papyraceus or a dead fetus related to ischemic/thrombotic events in the placenta and fetus. Volkmann ischemic contracture is rare in the newborn but can cause neonatal cutaneous defects. The cause of Volkmann ischemic contracture in newborns is unknown; however, our second observation suggests the possible role of a dead fetus.     

Linguistic environment of 1- to 2-year-old twins.

Investigated differences in the language learning environments of singletons and twins, with special reference to pragmatic factors that might be expected to differ in dyadic and triadic interactive situations. Six twin pairs and 12 singleton children (all firstborn) were observed in natural interactions with their mothers, once at 15 mo of age and again at 21 mo of age. Findings reveal that twins were lower than singletons on all measures of language development and that their language learning environments were significantly different. Although twin mothers spoke and interacted with their children as much as singleton mothers when twins were analyzed together, when analyzed as individuals, twin children received less speech directed specifically to them, participated in fewer and shorter episodes of joint attentional focus, and had fewer and shorter conversations with their mothers. Twin mothers were also more directive in their interactional styles. Correlational analyses indicated that variation of these language learning environment factors for the sample as a whole, and variation for some of these factors within the twin group itself, were related to early language growth. It is proposed that both the quantitative and qualitative differences observed in the language learning environments of singletons and twins derive from the nature of the triadic situation and that these differences have important effects on the child's early language development. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric complications of family reunion after four decades of separation

OBJECTIVE: After four decades of separation due to civil war, many people who had migrated to Taiwan from mainland China had the unexpected opportunity to briefly visit their families in mainland China. A study was conducted to examine psychiatric complications associated with these family reunions following long involuntary separation. METHOD: Eighty subjects who made the journey were given semistructured interviews investigating their psychological experiences relating to the family reunion. The variables investigated were sociodemographic characteristics, the subject's previsit emotional condition, factors related to the family reunion experience, and stress encountered during the visit. RESULTS: The survey indicated that more than one-fifth of the subjects (22.5%) developed psychiatric complications, mainly depression, immediately after the visit. Determinants found to contribute significantly to the occurrence of emotional disorders were previous ways of expressing homesickness, family members seen during the reunion, family misfortunes that the subjects discovered, family conflict encountered at the reunion, and tactics for coping with such stressors. CONCLUSIONS: The study results suggest that family reunions after long-term separation can be trauma-repairing experiences for some but for others can lead to trauma reexperiencing and psychiatric complications requiring mental health intervention.     

Two cases of cystic fibrosis in Japanese/German twins

We report a case of twins with cystic fibrosis. The twins are of mixed parentage, having a Japanese mother and a German father. One case presented with meconium ileus as a neonate. The other twin was relatively healthy until the age of 6, when she was first hospitalized with a diagnosis of pulmonary aspergillosis. They have been receiving standard therapies in the United States, including digestive enzymes, vitamins, and periodic antibiotics. At the age of 19 both patients received home intravenous antibiotic therapy, and began to use an inhaled DNase at the age of 20. When the patients were 19 they were screened for the common mutations causing cystic fibrosis, and the delta F508 CFTR mutation was identified. We analyzed their CFTR genes, as well as those of their Japanese mother and grandmother. Missense mutations at exon 7 (R347H) and exon 16 were found (D979A) in the twins and in their Japanese mother.