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