TY - JOUR
T1 - All for one and one delivery room approach for all?
AU - Kiefer, Autumn
AU - Rolfes, Julie Johnson
AU - Barretto, Greg
AU - Lantos, John D.
N1 - Publisher Copyright:
© 2020 by the American Academy of Pediatrics
PY - 2020/5
Y1 - 2020/5
N2 - Multiple births are increasing in frequency related to advanced maternal age and fertility treatments, and they have an increased risk for congenital anomalies compared to singleton births. However, twins have the same congenital anomalies,15% of the time. Thus, having multiple births with discordant anomalies is a growing challenge for neonatologists. Although external anomalies can often be spotted quickly at delivery or sex differences between multiples can rapidly identify those with internal anomalies described on prenatal ultrasound, we present a case of male multiples, who would optimally receive different initial resuscitation strategies on the basis of the presence or absence of an internal anomaly. The similar size of 4 extremely preterm quadruplets raises concern for whether accurate, immediate identification of 1 neonate with a congenital diaphragmatic hernia will be reliable in the delivery room. Clinicians discuss the ethical considerations of an “all for one” approach to this resuscitation.
AB - Multiple births are increasing in frequency related to advanced maternal age and fertility treatments, and they have an increased risk for congenital anomalies compared to singleton births. However, twins have the same congenital anomalies,15% of the time. Thus, having multiple births with discordant anomalies is a growing challenge for neonatologists. Although external anomalies can often be spotted quickly at delivery or sex differences between multiples can rapidly identify those with internal anomalies described on prenatal ultrasound, we present a case of male multiples, who would optimally receive different initial resuscitation strategies on the basis of the presence or absence of an internal anomaly. The similar size of 4 extremely preterm quadruplets raises concern for whether accurate, immediate identification of 1 neonate with a congenital diaphragmatic hernia will be reliable in the delivery room. Clinicians discuss the ethical considerations of an “all for one” approach to this resuscitation.
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U2 - 10.1542/PEDS.2019-2704
DO - 10.1542/PEDS.2019-2704
M3 - Article
C2 - 32241824
AN - SCOPUS:85086884711
SN - 0031-4005
VL - 145
JO - Pediatrics
JF - Pediatrics
IS - 5
M1 - e20192704
ER -