{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T05:30:05Z","timestamp":1784784605327,"version":"3.55.0"},"reference-count":29,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,10,17]],"date-time":"2024-10-17T00:00:00Z","timestamp":1729123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Monochorionic (MC) twins are at risk for severe twin-to-twin transfusion syndrome (TTTS) or twin anemia-polycythemia sequence (TAPS). In the case of preterm delivery, cesarean section (CS) with immediate umbilical cord clamping (ICC) of both twins is usually performed. While the recipient is at risk for polycythemia and may benefit from ICC, this procedure may result in aggravation of anemia with increased morbidity in the anemic donor. The purpose of this study was to demonstrate that the novel approach of selective extrauterine placental perfusion (EPP) with delayed umbilical cord clamping (DCC) in the donor infant is feasible in neonatal resuscitation of MC twins and may prevent severe anemia in donor and polycythemia in the recipient. Methods: Preterm MC twins with antenatal suspected severe anemia of the donor as measured by Doppler ultrasound, born with birthweights &lt; 1500 g by CS, were transferred to the neonatal resuscitation unit with placenta and intact umbilical cords. In the donor, the umbilical cord was left intact to provide DCC with parallel respiratory support (EPP approach), while the cord of the recipient was clamped immediately after identification. Results: Selective EPP was performed in three cases of MC twins with TAPS and acute peripartum TTTS. All donor twins had initial hemoglobin levels \u2265 13.0 g\/dL, and none of them required red blood cell transfusion on the first day after birth. Conclusions: Selective EPP may be a feasible strategy for neonatal resuscitation of MC preterm twins with high stage TAPS and TTTS to prevent anemia-related morbidities and may improve infant outcome.<\/jats:p>","DOI":"10.3390\/children11101256","type":"journal-article","created":{"date-parts":[[2024,10,18]],"date-time":"2024-10-18T05:03:49Z","timestamp":1729227829000},"page":"1256","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Selective Extrauterine Placental Perfusion in Monochorionic Twins Is Feasible\u2014A Case Series"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3131-8794","authenticated-orcid":false,"given":"Benjamin","family":"Kuehne","sequence":"first","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Trieschmann","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4812-9220","authenticated-orcid":false,"given":"Sarina Kim","family":"Butzer","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrin","family":"Mehler","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingo","family":"Gottschalk","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0477-5474","authenticated-orcid":false,"given":"Angela","family":"Kribs","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6856-9872","authenticated-orcid":false,"given":"Andr\u00e9","family":"Oberthuer","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.1056\/NEJMoa073059","article-title":"Intensive care for extreme prematurity\u2014Moving beyond gestational age","volume":"358","author":"Tyson","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.2105\/AJPH.92.8.1323","article-title":"The impact of the increasing number of multiple births on the rates of preterm birth and low birthweight: An international study","volume":"92","author":"Blondel","year":"2002","journal-title":"Am. J. Public Health"},{"key":"ref_3","first-page":"480","article-title":"Natural history of twin-twin transfusion syndrome","volume":"46","author":"Berghella","year":"2001","journal-title":"J. Reprod. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1080\/17474086.2017.1324290","article-title":"Hematological disorders at birth in complicated monochorionic twins","volume":"10","author":"Verbeek","year":"2017","journal-title":"Expert Rev. Hematol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1017\/thg.2016.18","article-title":"Twin Anemia Polycythemia Sequence: Current Views on Pathogenesis, Diagnostic Criteria, Perinatal Management, and Outcome","volume":"19","author":"Tollenaar","year":"2016","journal-title":"Twin Res. Hum. Genet."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1002\/uog.20096","article-title":"Improved prediction of twin anemia-polycythemia sequence by delta middle cerebral artery peak systolic velocity: New antenatal classification system","volume":"53","author":"Tollenaar","year":"2019","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1002\/uog.15821","article-title":"ISUOG Practice Guidelines: Role of ultrasound in twin pregnancy","volume":"47","author":"Khalil","year":"2016","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1002\/uog.20116","article-title":"Role of fetal intertwin difference in middle cerebral artery peak systolic velocity in predicting neonatal twin anemia-polycythemia sequence","volume":"53","author":"Fonseca","year":"2019","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"101221","DOI":"10.1016\/j.siny.2021.101221","article-title":"Delayed cord clamping in healthy term infants: More harm or good?","volume":"26","author":"Bruckner","year":"2021","journal-title":"Semin. Fetal Neonatal Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1038\/pr.2015.21","article-title":"Cardiovascular transition at birth: A physiological sequence","volume":"77","author":"Hooper","year":"2015","journal-title":"Pediatr. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1038\/jp.2016.151","article-title":"Placental transfusion: A review","volume":"37","author":"Katheria","year":"2017","journal-title":"J. Perinatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000488926","article-title":"Mask Continuous Positive Airway Pressure Therapy with Simultaneous Extrauterine Placental Transfusion for Resuscitation of Preterm Infants\u2014A Preliminary Study","volume":"3","author":"Kuehne","year":"2018","journal-title":"Biomed Hub"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e2340597","DOI":"10.1001\/jamanetworkopen.2023.40597","article-title":"Extrauterine Placental Perfusion and Oxygenation in Infants With Very Low Birth Weight: A Randomized Clinical Trial","volume":"6","author":"Kuehne","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1038\/sj.jp.7200292","article-title":"Staging of twin-twin transfusion syndrome","volume":"19","author":"Quintero","year":"1999","journal-title":"J. Perinatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"F102","DOI":"10.1136\/archdischild-2018-314898","article-title":"Supporting breathing of preterm infants at birth: A narrative review","volume":"104","author":"Martherus","year":"2019","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Martherus, T., Oberthuer, A., Dekker, J., Kirchgaessner, C., van Geloven, N., Hooper, S.B., Kribs, A., and Pas, A.B.T. (2019). Comparison of Two Respiratory Support Strategies for Stabilization of Very Preterm Infants at Birth: A Matched-Pairs Analysis. Front. Pediatr., 7.","DOI":"10.3389\/fped.2019.00003"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e1340","DOI":"10.1542\/peds.2009-1510","article-title":"Defining the reference range for oxygen saturation for infants after birth","volume":"125","author":"Dawson","year":"2010","journal-title":"Pediatrics"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1159\/000537904","article-title":"LISA Eligibility and LISA Success in Extremely Preterm Infants: A Single-Center Experience","volume":"121","author":"Klein","year":"2024","journal-title":"Neonatology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1002\/pd.2536","article-title":"Selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies","volume":"30","author":"Valsky","year":"2010","journal-title":"Prenat. Diagn."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1017\/thg.2021.46","article-title":"Large Hemoglobin Differences at Birth in Monochorionic Twins with a Placental Chorangioma and Delayed Cord Clamping","volume":"24","author":"Groene","year":"2021","journal-title":"Twin Res. Hum. Genet."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2223","DOI":"10.1016\/S0140-6736(23)02469-8","article-title":"Short, medium, and long deferral of umbilical cord clamping compared with umbilical cord milking and immediate clamping at preterm birth: A systematic review and network meta-analysis with individual participant data","volume":"402","author":"Seidler","year":"2023","journal-title":"Lancet"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ajog.2017.10.231","article-title":"Delayed vs early umbilical cord clamping for preterm infants: A systematic review and meta-analysis","volume":"218","author":"Fogarty","year":"2018","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1159\/000478844","article-title":"Persistent Pulmonary Hypertension of the Newborn in Twin-Twin Transfusion Syndrome: A Case-Control Study","volume":"112","author":"Gijtenbeek","year":"2017","journal-title":"Neonatology"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Polglase, G.R., Schm\u00f6lzer, G.M., Roberts, C.T., Blank, D.A., Badurdeen, S., Crossley, K.J., Miller, S.L., Stojanovska, V., Galinsky, R., and Kluckow, M. (2020). Cardiopulmonary Resuscitation of Asystolic Newborn Lambs Prior to Umbilical Cord Clamping; the Timing of Cord Clamping Matters!. Front. Physiol., 11.","DOI":"10.3389\/fphys.2020.00902"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2203300","DOI":"10.1080\/14767058.2023.2203300","article-title":"Delayed versus immediate cord clamping in dichorionic twins <32 weeks: A retrospective study","volume":"36","author":"Wang","year":"2023","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Yoon, S., Jin, Y., Kim, Y., Sung, J.-H., Choi, S.-J., Oh, S.-Y., and Roh, C.-R. (2023). Effect of delayed cord clamping on maternal and neonatal outcome in twin pregnancies: A retrospective cohort study. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-44575-9"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.earlhumdev.2018.08.002","article-title":"Effect of delayed cord clamping on very preterm twins","volume":"124","author":"Chiruvolu","year":"2018","journal-title":"Early Hum. Dev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"514.e1","DOI":"10.1016\/j.ajog.2008.03.050","article-title":"The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: A prospective cohort study","volume":"199","author":"Lewi","year":"2008","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1111\/j.1471-0528.2010.02781.x","article-title":"Measuring placental transfusion for term births: Weighing babies with cord intact","volume":"118","author":"Farrar","year":"2011","journal-title":"BJOG Int. J. Obstet. Gynaecol."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/10\/1256\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:15:38Z","timestamp":1760112938000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/10\/1256"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,17]]},"references-count":29,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["children11101256"],"URL":"https:\/\/doi.org\/10.3390\/children11101256","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,17]]}}}