title: Increased Risk Of Early-Onset Neonatal Sepsis After Laser Surgery For Twin-to-Twin Transfusion Syndrome.
abstract: To investigate the occurrence of early-onset neonatal sepsis (EOS) in twin-twin transfusion syndrome (TTTS) managed with laser surgery.
  
  
  
  We performed a prospective cohort study of all consecutive TTTS cases treated with laser surgery (TTTS group) delivered at the Leiden University Medical Center. We recorded the occurrence of EOS, defined as a positive blood culture ≤72 hours postpartum (proven sepsis) or administration of a full course of antibiotics due to risk factors or signs of sepsis, in the absence of a positive blood culture (suspected sepsis). Perinatal variables in the TTTS group were compared with uncomplicated monochorionic twins (no-TTTS group). A multivariate model was generated, examining the association between EOS and gestational age at birth, interval between laser surgery and birth, anterior placenta, laser period (first study period: 2002-2008; second study period: 2009-2015), and preterm premature rupture of membranes (PPROM).
  
  
  
  The rates of combined suspected and proven EOS in the TTTS group and no-TTTS group were 16% (68/416) and 10% (55/542), respectively (relative ratio [RR] 1.74, 95% confidence interval [CI] 1.19-2.55). Multivariate analysis showed that EOS in the TTTS group was independently associated with lower gestational age at birth (odds ratio [OR] 0.75, 95% CI 0.63-0.88), first study period (OR 2.25, 95% CI 1.08-4.67) and PPROM (OR 2.47, 95% CI 1.28-4.75).
  
  
  
  The rate of EOS in the TTTS group is low, but increased compared to the no-TTTS group. EOS in TTTS is independently associated with premature delivery, earlier laser period, and PPROM.
authors.affiliation: Division of Neonatology,Department of Pediatrics,Leiden University Medical Center,Leiden,the Netherlands.
authors.forename: Liselotte E M
authors.initials: LE
authors.lastname: van Kempen
authors.affiliation: Division of Neonatology,Department of Pediatrics,Leiden University Medical Center,Leiden,the Netherlands.
authors.forename: Depeng
authors.initials: D
authors.lastname: Zhao
authors.affiliation: Division of Neonatology,Department of Pediatrics,Leiden University Medical Center,Leiden,the Netherlands.
authors.forename: Sylke J
authors.initials: SJ
authors.lastname: Steggerda
authors.affiliation: Division of Pediatric Infectious Diseases,Department of Pediatrics,Leiden University Medical Center,Leiden,the Netherlands.
authors.forename: Vincent
authors.initials: V
authors.lastname: Bekker
authors.affiliation: Division of Fetal Medicine,Department of Obstetrics,Leiden University Medical Center,Leiden,the Netherlands.
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Middeldorp
authors.affiliation: Division of Fetal Medicine,Department of Obstetrics,Leiden University Medical Center,Leiden,the Netherlands.
authors.forename: Dick
authors.initials: D
authors.lastname: Oepkes
authors.affiliation: Division of Neonatology,Department of Pediatrics,Leiden University Medical Center,Leiden,the Netherlands.
authors.forename: Enrico
authors.initials: E
authors.lastname: Lopriore
mesh_terms: D017668:Age of Onset; D005260:Female; D005330:Fetofetal Transfusion / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery; D005865:Gestational Age; D006801:Humans; D017075:Laser Coagulation; D000071074:Neonatal Sepsis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D011247:Pregnancy; D059285:Pregnancy, Twin; D047928:Premature Birth / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors; D014430:Twins, Monozygotic
keywords: early-onset neonatal sepsis; laser surgery; twin–twin transfusion syndrome