title: Fatal pulmonary embolism in a premature neonate after twin-to-twin transfusion syndrome.
abstract: Thrombotic events are being increasingly recognized during the neonatal period. An infant girl was born at 29 weeks' gestation after a pregnancy complicated by twin-to-twin transfusion syndrome. After an initial uncomplicated clinical course, her oxygen requirement increased, which was interpreted as an early sign of bronchopulmonary dysplasia. At 3 weeks of age, she suddenly collapsed and died of severe pulmonary hypertension. At autopsy, multiple pulmonary artery emboli and several older renal vein thromboses were found. Results of genetic analyses of the infant and her family were negative for thrombophilia. Although embolism represents a frequent emergency in adults, fatal pulmonary embolism has never, to our knowledge, been described for premature infants. This case suggests that thrombotic events are underdiagnosed and that additional studies are needed to define infants at risk and optimal treatment strategies.
authors.affiliation: Department of Pediatrics, University of Bern, Bern, Switzerland. luregn.schlapbach@insel.ch
authors.forename: Luregn Jan
authors.initials: LJ
authors.lastname: Schlapbach
authors.forename: Thomas
authors.initials: T
authors.lastname: Riedel
authors.forename: Vera
authors.initials: V
authors.lastname: Genitsch
authors.forename: Mathias
authors.initials: M
authors.lastname: Nelle
authors.forename: Felicity Jane
authors.initials: FJ
authors.lastname: McDougall
mesh_terms: D001803:Blood Transfusion / Q000379:methods*; D004200:Diseases in Twins; D005260:Female; D005330:Fetofetal Transfusion; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D011247:Pregnancy; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000628:therapy*; D013902:Radiography, Thoracic; D013577:Syndrome