The effect of delays in feeding colostrum and the relationship between immunoglobulin concentration in the serum of neonatal calves and their rates of growth

Eighty-five unsuckled newborn calves, were fed 1.5 L of colostrum of known IgG concentration at either 2, 4, 6 or 8 hours after birth with no additional colostrum feeding. Another group of 11 calves were left with their dam for 16 hours after birth, before separation. Blood samples were taken from all calves 24 hours after colostrum feeding or separation from the dam and serum Ig concentrations were measured by electrophoresis. There were no significant differences in mean serum Ig concentrations between calves fed at the different times after birth. Three of the 11 calves left to suckle were hypogammaglobulinaemic. Other calves in this group had higher serum Ig concentrations than the means of all other groups. All groups had mean serum Ig concentrations higher than the suggested minimum concentration required for adequate calf health. There were a number of calves that did not reach the suggested minimum serum concentration after feeding, but calf mortality was low and all calves were healthy apart from a slight scour for a few weeks after birth. There was no significant relationship between serum Ig concentration 24 to 48 hours after birth and either calf mortality or average growth rate over an 8- to 10-month period.     

Thyroid hormones in dairy calves after birth and in the first days of life. Amplitude of variation, maternal-fetal relationships and reaction patterns specific to the individual

Dairy calves and their dams from the dairy herd of the institute were used for this investigation. Calvings were watch carefully and jugular venous blood samples taken immediately after delivery from the cow and the calf and in the calf at 24 hours and at 48 hours of postnatal age as well were analyzed for T4, FT4, T3 and FT3 by luminescence enzyme immunoassay (LEIA). Higher thyroid values in calves than in their dams could be found increasing short after birth and reaching their highest level within 24 hours of postnatal life. The individual thyroid hormone values at birth and at 24 hours and at 48 hours of age are well correlated meaning the changes during the first days are specific for each calf. Strong correlation between the thyroid hormone values of the cows and those of the calves could be found. Mean values of thyroid hormones were significantly higher in female than in male calves all time but not different in the dams of these calves.     

Nitroglycerin and ventricular performance. Differential effect in the presence of reversible and irreversible asynergy

During the five-year period 1964-68 96 733 births were registered in the 28 hospitals equipped with maternity facilities in the Uppsala hospital region. Of these babies, 1 636 were born in 818 twin deliveries. Data on gestational age, sex, weight and length at birth, birth order, hospital type, congenital malformations and perinatal mortality are analysed. Altogether 17.3 per 1 000 of the children born during this period were born in multiple births. The perinatal mortality for the twin babies was 64 per 1 000 born, with the mortality higher in the less specialized hospitals than the others. Twin no. 1 suffered perinatal death in 67 cases per 1 000 and twin no. 2 in 60 cases per 1 000. For twins of primiparae the losses were 92 per 1 000 children and for twins born to multiparae 51 per 1 000. Altogether 72 per 1 000 male twins died perinatally compared to 52 per 1 000 female twins. The most heavy losses occurred among the low-weight premature twins and in these cases both twins often suffered perinatal death.     

Lower risks of adverse outcome in twins conceived by artificial reproductive techniques compared with spontaneously conceived twins

The outcomes of twins conceived by 136 women after medical assistance (MA) such as ovulation induction with or without assisted reproductive techniques, and twins conceived spontaneously (SP) by 72 women were compared. All 208 women were monitored from < 20 weeks gestation; they all delivered at > or = 24 weeks gestation. The chorionicity of the placenta was diagnosed antenatally and confirmed after delivery. There were 10 perinatal deaths; the physical and neurological status of the remaining 406 infants was assessed at 1 year of corrected age. There were no differences in gestational age at birth, the birth weights of the larger and smaller twins, the birth weight discordance, or the incidence of life-threatening major malformations between groups. Adverse infant outcomes, such as death, cerebral palsy and mental retardation occurred in nine (3.3%) of 272 MA twins compared with 12 (8.3%) of 144 SP twins (P < 0.05). The placenta was monochorionic in only three (2.2%) of 136 MA twin pregnancies compared with 41 (57%) of 72 SP twin pregnancies (P < 0.001). Of the 21 infants with adverse outcomes, nine had monochorionic placentas. Thus, the risk of an adverse outcome was 2.8-fold higher (95% confidence interval (CI) 1.2-6.4) in monochorionic twins than in dichorionic twins (10 versus 3.7%; P < 0.05). There was no difference in the incidence of adverse infant outcomes between SP (4.8%) and MA (3.4%) twins with dichorionic placentas. These findings suggest that ovulation induction in itself was not associated with an adverse outcome of twin pregnancies. The lower frequency of monochorionic placentas in MA twins may have been responsible for the lower risk of an adverse outcome in MA twins.     

Acute and chronic fetal hypoxia in monochorionic and dichorionic twins

OBJECTIVE: To assess the risk for acute and chronic fetal hypoxia in twin pregnancies. METHODS: We investigated 50 sets of twins (24-38 weeks' gestation, 660-3200 g birth weight) admitted consecutively to our neonatal intensive care unit. Seventy-six infants were appropriate for gestational age (AGA; tenth to 90th percentile), 20 were small for gestational age (SGA; below the tenth percentile), and four were large for gestational age (above the 90th percentile). Twenty-six singleton AGA term newborns served as controls. Umbilical arterial pH was used as a marker for acute and umbilical venous erythropoietin concentration for chronic fetal hypoxia. The results are given as median followed by quartiles. RESULTS: We identified 40 sets of diamniotic-dichorionic twins and ten sets of diamniotic-monochorionic twins with transplacental vascular shunts. In the second-born twin, umbilical arterial pH was lower (7.29, 7.23-7.33) than in the firstborn (7.31, 7.25-7.34) (P = .03), and the incidence of a low pH (less than 7.20) was higher (19 versus 11%). Two second-born twins and none of the firstborn twins had an umbilical arterial pH less than 7.05. In SGA twins, the erythropoietin concentration was elevated (34.8, 22.8-325 mU/mL) compared with that in AGA twins (16.2, 8.2-26.6 mU/mL) (P < .01). In AGA twins, erythropoietin concentration did not differ from that in AGA singleton newborns (19.6, 14.7-31.6 mU/mL). In 12 of 17 twin sets with weight discordancy greater than 15% and in all five twin sets with weight difference greater than 25%, erythropoietin concentration was higher in the smaller twin. The proportion of infants and of complete sets with elevated erythropoietin levels was higher (P < .01) in monochorionic than in dichorionic pregnancies. CONCLUSION: The second-born twin is at increased risk for acute birth asphyxia. Fetal growth restriction in twin pregnancies is associated with chronic fetal hypoxia. Monochorionic twins are at higher risk for chronic fetal hypoxia than are dichorionic twins.     

Serum immunoglobulin G concentration in goat kids fed colostrum or a colostrum substitute

To determine the suitability of a new colostrum substitute derived from goat serum and to determine the amount of colostral IgG needed to achieve serum IgG concentration > 800 mg/dl, twin kids from 14 does were fed colostrum or a colostrum substitute. The volume of colostrum or colostrum substitute fed was calculated so that half the kids in each group received IgG at a low dosage (1.5 g/kg of body weight) and the other half received IgG at a high dosage (3 g/kg). Kids were bottle fed the colostrum or colostrum substitute and then fed pooled goat's milk until 18 hours old, at which time they were allowed to nurse their dams. Does were milked manually every 2 hours after parturition until specific gravity of mammary secretions was < 1.02, the specific gravity of goat's milk. Serum IgG concentration of each kid was determined by means of single radial immunodiffusion at birth and 12, 18, and 24 hours and 7, 21, and 42 days after birth. Kids were weighed at each blood collection and monitored for illness daily. None of the kids had measurable serum IgG concentrations at birth. Mean serum IgG concentration was significantly higher in kids fed colostrum than in kids fed colostrum substitute at all times, except days 7 and 42 (P < 0.05). By 24 hours after birth, serum IgG concentration was > 800 mg/dl in all kids fed colostrum, in 4 of 7 kids fed the substitute at the higher dosage, and in 2 of 7 kids fed the substitute at the lower dosage.(ABSTRACT TRUNCATED AT 250 WORDS)     

Bone mineral assessments in the calcaneus after anterior cruciate ligament injury. An investigation of 92 male patients before and two years after reconstruction or revision surgery

Dairy calves under 14 days of age with naturally occurring, uncomplicated diarrhea were treated for 3 days with a hypertonic oral electrolyte solution with (n = 15) or without (n = 12) psyllium. Clinical response and clinical pathology data were compared between the 2 groups. Glucose absorption was evaluated on days 1 and 3 by measurement of plasma glucose and lactate and serum insulin concentrations for 4 hours after formula administration. On day 1, glucose, lactate, and insulin concentrations were lower in psyllium-fed calves than in control calves, with significant differences noted in glucose and lactate concentrations at several time points (P < 0.05). Plasma lactate concentrations were higher at several times in both treatment groups on day 3 than on day 1 (P < 0.05). Fecal consistency was markedly different in psyllium-fed calves as compared with control calves within 24 hours of psyllium supplementation. Fecal percent dry matter content was lower in psyllium-fed calves than in control calves at least once a day during supplementation and on day 3 compared with day 0 in the psyllium-fed calves (P < 0.05). There were no significant differences in clinical performance scores, hydration status, arterial blood gas, serum anion gap, electrolyte, or total CO2 concentrations. Addition of psyllium to an oral electrolyte solution resulted in immediate alterations in glucose absorption without impairing rehydration in diarrheic calves, but differences were transient and did not affect clinical outcome.     

Influence of environment on passive immunity in calves

Passive immunity in neonatal calves is influenced by environment. Placing newly born Holstein calves (108 head) in three different housing environments (shade, cooled shade, hutch) during hot weather produced differences in body temperature, serum cortocosteroids, immunoglobulin IgG1 concentrations, and mortality. Experimental design permitted examination of effects due to treatments, time, differences in colostrum, and climatic environment in an analysis of variance. Calves exposed to the hotter, less desirable environment responded by having a higher mortality, higher serum corticosteroid concentration, and lower serum immunoglobulin IgG1 at 2 and 10 days after birth. All of these were correlated. Calves that died had serum immunoglobulin IgG1 falling below the mean for all experimental calves.     

3-Dimensional anatomic relationship of serotonergic and muscarinic receptor binding in the pontine reticular formation of the human infant brainstem

The present trial deals with the effects of birth stress on the thyreoidea respectively on the thyroxine- and triiodthyronine-concentration as well as on their unbound fraction (FT4 and FT3) of suckler calves and the evolution of those parameters in the first three months of life. T4- and T3 concentrations in blood serum of calves were beyond maternal levels increasing significantly in the first 24 hours with strong individual specificity and reaching levels of adult animals at the end of the three-month-period. The different increasing rates of the four parameters show a stimulation of the thyreoideal activity and of the monodejodinase-system as well and they show also a greater decomposition rate of the binding proteins. An influence of the course of parturition on the T3 level p.n. and the T4/T3 ratio in the first 24 hours could be disclosed. The hormone concentrations p.n. showed correlations to the pH and pCO2 of the neonatal calves. For T4 and T3 a strong influence of maternal levels on the hormone levels of the calves p.n. could be ascertained. Effects of breed, surrounding temperatures and type of husbandry on the investigated parameters could be established.     

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.     

Clinical, haematological, metabolic and endocrine traits during the first three months of life of suckling simmentaler calves held in a cow-calf operation

Newborn suckling Simmentaler calves (10 males and 9 females) in a cow-calf operation were examined from birth up to the age of 3 months. The average daily gain from 47 to 120 kg was 0.86 kg. Except for higher average daily weight gains and insulin-like growth factor-I concentrations and lower thyroid hormone levels in male than female calves, there were no significant sex differences. Plasma glucose, total protein and immunoglobulin G concentrations increased on day 1 of life, thrombocyte number and plasma triglyceride concentrations rose during the first 7 days, whereas lymphocyte and monocyte percentage and plasma inorganic phosphorus, phospholipid, cholesterol and albumin concentrations increased during the first 14 or 21 days and then remained elevated. Eosinophil percentage increased after 3 weeks and insulin-like growth factor-I concentrations increased over the whole growth period. There were transient elevations of plasma glucagon concentrations up to day 14, of the activity of alkaline phosphatase transiently up to day 7 and of gamma-glutamyltransferase, aspartate aminotransferase and lactate dehydrogenase activities on day 1 of life. Plasma iron concentration transiently decreased up to day 28 and creatine kinase activity up to day 7. Total white blood cell number, neutrophil percentage, packed cell volume and concentrations of haemoglobin, calcium, magnesium (after a transient rise on day 1), non-esterified fatty acids, bilirubin, creatinine, triiodothyronine and thyroxine decreased from birth up to days 42, 56, 28, 28, 21, 84, 14, 14, 7, 14 and 7, respectively. Basophil percentage and concentrations of beta-hydroxybutyrate, urea and insulin did not exhibit significant age-dependent changes. The behaviour of most traits in the first weeks was the same in suckling calves under study as in non-suckling pre-ruminant calves. However, packed cell volume, red blood cell number, haemoglobin and plasma iron concentrations were higher, whereas glucose and insulin concentrations were lower than normally found in veal calves. On the other hand, concentrations of glucose, insulin and insulin-like growth factor-I in suckling calves in the third month of age were higher than can normally be measured in breeding calves.     

Genotypic effects on norepinephrine-induced changes in thermogenesis, metabolic hormones, and metabolites in newborn calves

Heat production was measured in newborn Angus-, Brahman-, and Tuli-sired calves born to Angus (n = 20) and Brahman (n = 26) dams, before (thermoneutral metabolic rate, TMR) and after norepinephrine (NE) infusion (peak metabolic rate, PMR), to assess genotypic effects on nonshivering thermogenesis in brown adipose tissue. Calves were fed pooled colostrum, fitted with jugular catheters, and placed in a temperature-controlled (37 degrees C) water immersion system. Heat production, determined by indirect calorimetry, and tympanic temperature were measured continuously in calves from approximately 3 to 6 h of age. Blood samples were collected at birth and at 0, 5, 20, 40, 60, 80, 100, and 120 min relative to NE infusion (35 micrograms.min-1.kg BW-1 for 4 min), and plasma was analyzed for metabolites (glucose, NEFA, and urea nitrogen [PUN]) and hormones (cortisol, triiodothyronine [T3] and thyroxine [T4]). Weight-specific TMR (cal.min-1.kg-1) was not affected by breed of sire or dam, although weight-specific PMR (cal.min-1.kg-1) was lower (P < .01) in Brahman-sired calves than in Angus- or Tuli-sired calves and was lower (P < .001) in calves born to Brahman rather than Angus dams. The reduction in weight-specific PMR due to the maternal Brahman influence was sire-breed dependent, and the reduction was largest (P < .01) for Tuli-sired (34.3%), intermediate (P < .05) for Brahman-sired (15.1%), and lowest (P > .25) for Angus-sired calves (4.1%). The PMR:TMR ratio was 1.80 and 2.21 +/- .06 in calves born to Brahman and Angus dams, respectively. Peak tympanic temperature was .6 degree C lower (P < .01) in calves born to Brahman rather than Angus dams. At birth, plasma NEFA concentrations were higher (P < .001) and glucose tended (P = .13) to be higher in calves born to Brahman rather than Angus dams. Cortisol, T3, and T4 concentrations at birth were higher in calves born to Brahman dams than in those born to Angus dams. These results suggest that calves born to Brahman dams may have less thermogenically active brown adipose tissue than calves born to Angus dams, which may contribute to the relative cold intolerance of calves with Bos indicus inheritance.     

Examination of the total protein concentration and gamma-glutamyltransferase (gamma-GT) in calves during the first 14 days of life and their significance for predictions of health status in the first two postnatal weeks]

The objective of the present paper was to examine the development of the total protein concentration in blood serum and the gamma-GT activity in 49 calves in relation to the health status during the first 14 days of life. For this purpose, blood samples were taken immediately after birth of the animals, after 6, 12, 18 and 24 hours and from then onwards once a day with the calves being subject to a thorough clinical examination each time. All calves received pooled colostrum. At the end of the experiment, the calves were subdivided into three groups on the basis of their health status, i.e. control calves, calves with a slight or moderately severe disease and calves suffering from a severe disease. In all three groups the total protein concentration increased significantly after the colostrum intake and decreased slowly from the 2nd day of life onwards. The gamma-GT activity as well increased significantly after the colostrum intake and decreased rapidly after 12th hour of life and progressively in the further course of the experiment. Both parameters varied considerably from one calf to the next and no statistically significant differences in these parameters between the three groups could be found. It can thus be deduced that the total protein concentration in blood serum and the gamma-GT activity do not allow any predictions about the development of the health status during the first 14 days of life to be made.     

Five-year follow-up after balloon pulmonary valvuloplasty

We hypothesized that gender and intrauterine growth retardation (IUGR) have greater effects than birth order on mortality and morbidity rates of very low birth weight (< 1501 gm) twins. Neonatal data were collected on 44 pairs of twins born alive between January 1984 and December 1987. Birth weight was 1018 +/- 289 gm and gestational age was 28.1 +/- 2.5 weeks. The male/female ratio was 46:42; 24 infants had IUGR, and 64 were appropriate in size for gestational age. Of the 88 infants, 61 (69%) survived. Birth order had no effect on outcome. Female twin pairs had a longer gestation than either male twin pairs or twins with discordant sex (29.2 +/- 2.5 weeks vs 27.4 +/- 2.0 weeks and 27 +/- 3 weeks, respectively; p < 0.002). They also had a lower mortality rate (14% vs 47% and 25%; p < 0.001) and a lower incidence of bronchopulmonary dysplasia (22% vs 57% and 50%; p < 0.02). Infants with IUGR had an increased mortality rate (50% vs 23%; p < 0.02) and an increased sepsis rate (61% vs 25%; p < 0.02) compared with infants with appropriate size for gestational age who were matched for gestational age. Multiple logistic regression analysis to assess the independent effects of gestational age, gender, and IUGR on mortality rate, bronchopulmonary dysplasia, and intraventricular hemorrhage revealed that gestational age was the most significant contributor to all three outcome variables; IUGR contributed to an increased mortality rate, and male gender contributed to the occurrence of bronchopulmonary dysplasia.     

Zygosity and intrauterine growth of twins

Six hundred seventy-eight sonar measurements of the fetal biparietal diameter (BPD) were used to assess the intrauterine growth of 182 twins between 18 and 40 weeks' gestation. These values, as well as the weight and body length at birth, were related to the zygosity, which was determined by sex of the infants, histologic examination of placenta, or blood grouping. The mean BPD of twin 1 was larger than that of twin 2 in both monozygotic and dizygotic pairs throughout the study period (P less than .001). The size of BPD of the dizygotic infants exceeded that of the monozygotic among both twin 1 (P less than .001) and twin 2 (P less than .001). The absolute intrapair differences of birth length and weight were larger among dizygotic than among monozygotic twins. These findings suggest that in late pregnancy a substantial one-way intertwin transfusion among monochorial twins does not occur frequently enough to mask the inherent genetically determined similarity between the twins. The appearance already in the second trimester of the difference in the longitudinally monitored BPD between monozygotic and dizygotic twins suggests that the discrepancy is determined early in gestation.     

Effects of the level of asphyxia during delivery on viability at birth and early postnatal vitality of newborn pigs

Newborn pigs (n = 117) were used to provide information on the relationships of degree of asphyxia during delivery, viability at birth, and some striking aspects of postnatal vitality including survival, interval between birth and first udder contact and between birth and first suckling, rectal temperature at 24 h of life (RT24), and growth rate over the first 10 d of life. The degree of asphyxia at birth was estimated from cord blood pCO2, pH, and lactate levels. Onset of respiration, heart rate, skin color, and attempts to stand during the first minute after birth were used to estimate the viability score. Neonatal asphyxia, i.e., decreased blood pH and increased blood pCO2 and lactate, was associated with the production of unusually high levels of catecholamines. The degree of asphyxia increased with late position in the birth order (P < .01) and was higher in piglets born posteriorly (P < 0.5). Further, the average blood pCO2 within a litter increased (P < .05) with litter size. The was an inverse relationship between the degree of asphyxia and the viability score (P < .001). Highly viable piglets reached the udder more rapidly (P < .001) and had a higher RT24 (P < .001) than those of low viability. Plasma glucose concentrations increased with blood pCO2 and plasma epinephrine concentrations (P < .001). Neonatal asphyxia reduced postnatal vitality by delaying the first contact with the udder (P < .03) and was associated with a lower RT24 (P < .05), growth rate (P < .001), and survival over 10 d (P < 0.06). These variables, i.e., interval between birth and first udder contact, RT24, and growth rate, were correlated with birth weight (P < .001); RT24 was also shown to decrease (P < .001) with the time taken to reach the udder. Overall, results suggest that piglet suffering from asphyxia during delivery are less viable at birth and less prone to adapt to extrauterine life.     

Immunoglobulin transfer in the viable, newborn calf

Parturitions of 26 dairy-cows were observed and the viability of the newborn calves assessed. Immediately after birth as well as after the first and forth colostrum intake a blood probe was taken from the neonates and investigated for the following parameters: blood gas, blood picture, total-IG, concentrations of IGG1, IGM and IGE, total proteins and albumin. Before each feeding a colostrum sample was assayed for the same parameters with the exception of blood gas, blood picture and albumin. A transferindex (KLOBASA et al., 1994) was calculated to investigate the absorption of TP, IG, IGG1, IGM and IGE. In some of the blood samples there was no IGE detectable, even after colostrum intake. High individual differences were striking and blood concentrations were not related to the milk contents or the time until first feeding. The total proteins were strongly correlated to the serum concentrations of IGG1, but only in samples taken after first colostrum feeding. Vital calves showed the following tendency: colostrum intake of less than 1 l within the first 15 hours after birth and/or colostrum intake with TP-concentrations of 80 I.U./l was partly compensated by increased absorption of TP. 24 hours after birth serum-immunoglobulinconcentrations were 6-12 mg/ml; weight gain was normal and no calf became ill. In 60% of cases the transferindex for IGM was higher than for IGG1 or IGE.     

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.     

Neonatal outcome depending on the mode of delivery and fetal presentation in twin gestation

A retrospective analysis of 301 twin deliveries managed at The Second Department of Obstetrics and Gynecology, Warsaw Medical Academy, from January 1, 1986 to December 31, 1995 was undertaken in order to investigate the impact of the mode of delivery and twin presentation on neonatal outcome. Vertex presentation of both twins was the most common with an incidence of 47.5% followed by vertex-non-vertex (27.6%) and nonvertex presentation of the first twin (24.9%). 186 (61.8%) patients delivered vaginally, while 115 (38.2%) women underwent caesarean section including 6 operations performed after the vaginal delivery of the first twin. In vertex presentation of the first twin and breech second twin there was no significant difference in neonatal outcome measured by 5-minute Apgar score and birth trauma incidence between second twins delivered vaginally and second twins delivered by caesarean section. Vaginal delivery with internal podalic version of the second twin in vertex-transverse presentations was related to increased risk of lower 5-minute Apgar score and increased risk of birth trauma occurrence compared to caesarean section. Time interval between vaginal delivery of twins had no significant impact on neonatal outcome.     

Successful early separation of a premature xipho-omphalopagus conjoined twins: a case report

Premature xipho-omphalopagus conjoined twins were successfully separated at 7 days of age. The total body weight of the twins before separation was 3502 g. One twin had persistent patent ductus arteriosus and signs of cardiac failure at 4 days of age. This was managed with indomethacin. Thirty-six hours later the second twin became anuric, necessitating early emergency separation. The twins were joined from the lower sternum to the infraumbilical area. The liver was fused, but there was no major vascular connection. There were no other major anomalies. The babies stood the procedure well and were healthy at follow-up 8 months after separation.