{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T12:47:07Z","timestamp":1785934027161,"version":"3.56.0"},"reference-count":10,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,7,24]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>Monochorionic monoamniotic twin pregnancies carry substantial perinatal risk, with co-twin demise potentially causing acute twin-to-twin exsanguination in the survivor. Resultant profound anaemia and cardiovascular compromise may lead to severe acute kidney injury (AKI), while peritoneal dialysis (PD) in premature neonates remains technically challenging because of low birth weight and limited access options. We report a female infant born at 31+6 weeks\u2019 gestation following intrauterine co-twin demise from cord entanglement. She developed profound anaemia, metabolic acidosis and anuric stage 3 AKI secondary to acute exsanguination. Despite maximal medical therapy, respiratory deterioration from fluid overload necessitated PD on day 19 of life. Peritoneal access required adaptive strategies, including the use of a biliary drainage catheter. Following dialysis initiation, the infant achieved euvolaemia, respiratory improvement and renal recovery before transfer to a national dialysis and transplant centre. This case demonstrates the feasibility of PD in critically ill low-birth-weight preterm infants.<\/jats:p>","DOI":"10.1136\/bcr-2026-272248","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T11:55:11Z","timestamp":1785930911000},"page":"e272248","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Survival following twin-to-twin exsanguination in monoamniotic twins: management with peritoneal dialysis"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8030-9342","authenticated-orcid":false,"given":"Boon Siew","family":"Ooi","sequence":"first","affiliation":[{"name":"Department of Neonatology, KK Women\u2019s and Children\u2019s Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siew Le","family":"Chong","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Medicine, Nephrology Service, KK Women\u2019s and Children\u2019s Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celeste Jia Ying","family":"Yap","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Medicine, Nephrology Service, KK Women\u2019s and Children\u2019s Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8301-9262","authenticated-orcid":false,"given":"Odattil","family":"Geetha","sequence":"additional","affiliation":[{"name":"Department of Neonatology, KK Women\u2019s and Children\u2019s Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"2026080504550721000_19.8.e272248.1","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1002\/uog.19114","article-title":"Prevalence, antenatal management and perinatal outcome of monochorionic monoamniotic twin pregnancy: a collaborative multicenter study in England, 2000-2013","volume":"53","author":"Glinianaia","year":"2019","journal-title":"Ultrasound Obstet Gynecol"},{"key":"2026080504550721000_19.8.e272248.2","doi-asserted-by":"publisher","DOI":"10.1159\/000304512"},{"key":"2026080504550721000_19.8.e272248.3","first-page":"1017","article-title":"Acute kidney injury in preterm infants: short- and long-term effects","volume":"80","author":"Goldstein","year":"2011","journal-title":"Kidney Int"},{"key":"2026080504550721000_19.8.e272248.4","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-012-2369-4"},{"key":"2026080504550721000_19.8.e272248.5","first-page":"375","article-title":"Neonatal acute kidney injury: current knowledge, gaps and future directions","volume":"37","author":"Selewski","year":"2022","journal-title":"Pediatr Nephrol"},{"key":"2026080504550721000_19.8.e272248.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12882-020-02092-1","article-title":"Challenges of acute peritoneal dialysis in extremely-low-birth-weight infants: a retrospective cohort study","volume":"21","author":"Noh","year":"2020","journal-title":"BMC Nephrol"},{"key":"2026080504550721000_19.8.e272248.7","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.24953\/turkjped.2020.06.020","article-title":"Peritoneal dialysis as a life-saving procedure in an extremely low birth weight infant: case report and review of the literature","volume":"62","author":"\u00c7etinkaya","year":"2020","journal-title":"Turk J Pediatr"},{"key":"2026080504550721000_19.8.e272248.8","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfu095"},{"key":"2026080504550721000_19.8.e272248.9","doi-asserted-by":"crossref","first-page":"898","DOI":"10.4103\/1319-2442.336795","article-title":"Peritoneal Dialysis with Cook\u00ae Pigtail Catheter in an Extreme Low-Birth-Weight Baby with Anuric Renal Failure","volume":"32","author":"Saha","year":"2021","journal-title":"Saudi J Kidney Dis Transpl"},{"key":"2026080504550721000_19.8.e272248.10","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-011-1939-1"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-272248","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T11:55:12Z","timestamp":1785930912000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-272248"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":10,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,5]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/bcr-2026-272248"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-272248","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}