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A Look at Laser Ablation Therapy for
Twin-to-Twin Transfusion Syndrome From
a Nurse’s Eyes
Poster Presentation
One in every 80 couples will walk into their
scheduled ultrasound to ¢nd that they have
been blessed with twins. One third of those will be
monochorionic and diamniotic twin pregnancies
that have a single placenta shared between two
babies, where each sits in its own £uid sac. Approx-
imately 15% to 20% of these twins develop a
life-threatening condition known as twin-to twin-
transfusion syndrome (TTTS), which can transform
a happy twin pregnancy into a nightmare.
At one point in timeTTTS meant severe morbidity or
a fatality of one or both of the twins. Thanks to to-
day’s technologies, we now have interventions,
such as selective laser ablation surgery of the con-
necting vessels on the placenta that are causing
the transfusion syndrome, by which morbidity and
mortality of the fetus is greatly reduced. There is a
center in one of the leading hospitals in the United
States that performs these life-saving procedures,
one of only the four in the country. Within the walls
of this hospital, weekly multidisciplinary meetings
occur to discuss each case. These meetings in-
clude an array of physician, health care, and non-
health-care groups such as fetal surgeons, cardiol-
ogists, geneticists, internalists, fetal medicine
physicians, social workers, ethicists, operating
room nurses, and many more. Eventually, those
cases deemed appropriate for selective laser abla-
tion are provided that option. The overall morbidity
and mortality that result from laser ablation surgery
are much lower than those of other possible
interventions for this disease. Although not a wide-
spread intervention yet, as technologies continue to
develop, laser ablation surgery is the wave of the
future in treatment of TTTS.
Emerging Science: New Hope in Harlequin
Ichthyosis
Poster Presentation
Harlequin ichthyosis (HI) is a congenital skin
disorder ¢rst described by Reverend Oliver
Hart in 1750, and the incidence of this rare disorder
is 1 in 300,000. This defect of lipid transport is mani-
fested in a hyperkeratotic epidermis, resulting in
restriction of movement, deep ¢ssures in the skin,
and inelasticity. Characteristically, the mouth is
¢xed in the shape of an ‘‘O,’’ the infant is unable to
adequately suck, and severe ectropion may be
present (Makhopadhyay & Agarwal, 2006). There
may be impaired circulation due to hyperkeratotic
bands. Diagnosis may be made based on appear-
ance at birth as the name harlequin is derived from
the diamond-like patches apparent on the skin.
Most infants die in the neonatal period due to infec-
tion and metabolic issues. Management for HI
includes supportive care, emollition of the skin, pre-
vention of infection, hydration, and electrolyte
replacement. In recent years, some patients have
survived into adolescence and adulthood.
When a premature newborn with HI was transferred
to our regional center, a family-centered plan of
care was set in motion, which evolved from pallia-
tive therapy to disease management and support.
Our baby girl had a sibling who died at 48 hours of
life 1 year earlier at our nearby children’s hospital,
but the family was lost to follow-up. No testing had
been done during the second pregnancy, so the di-
agnosis was made at birth, and a decision was
made to o¡er palliative care. At 24 hours of life, the
baby’s family expressed that they believed she was
Mandeep Kaur, RN, BSN,
School of Nursing, The Uni-
versity of Texas—Austin,
Austin, TX
Cheryl-Lynne B. Kitts, MSN,
RNC-OB Nursing, Christiana
Care Health Services, Newark,
DE
Diane Eckles, CPN, MSN,
Nursing, Christiana Care
Health Services, Newark, DE
JOGNN C A S E S T U D I E S
Proceedings of the 2010 AWHONN Annual Convention
S132 & 2010 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses http://jognn.awhonn.org
Newborn
Care