Two preterm newborn twins at 35 weeks of gestational age are products of monochorionic pregnancy monochorionic twin pregnancy, whose mother denies parental consanguinity and reports a confirmed history of miscarriage associated with a syndrome.
Second normal pregnancy, fetal karyotype was not performed, adequate prenatal controls were performed, and there was no evidence of complications until week 35. At this time, twin obstruction and possible intestinal ischemia were identified by obstetric ultrasound.
Given the above, she was scheduled for emergency cesarean section.
The first twin was obtained with a weight of 2,520 g, height of 47 cm APGAR score at the first minute, 5 min and 10-10 respectively, showing marked twin APGAR score of 47 cm and 10 cm, respectively.
At birth, twin #2 was adapted without problems, however, twin #1 presented an episode of apnea that was managed by positive pressure ventilation (PPV), which responded satisfactorily.
It was decided to pass a nasogastric tube through which abundant bilious fluid was drained.
microcolony was evidenced in the neonatal intensive care unit and was adapted to mechanical ventilation taking into account the high risk of bronchoaspiration; among the paraclinical tests, a simple abdominal x-ray showed signs of distal intestinal obstruction b
Surgical management was decided by laparotomy, with the following intraoperative findings: gallbladder hypoplasia, intestinal hypoplasia, presence of multiple stenosis and meconium ileus that affected the ileum and the colon, with proximal segment resection of colon.
In the first 4 postoperative days he received parenteral nutrition and later enteral nutrition was started.
Perceived intestinal motility decreased and present high stoma was decided to administer prokinetic agent and on the sixth postoperative day an enema was performed, after which finally presented meconium.
Considering the association of meconium ileus as one of the first manifestations of cystic fibrosis, it was decided to perform a molecular study in both brothers.
DNA sample was taken from blood samples, amplification was performed polymerase chain reaction (PCR) with specific PCR (polymerase chain reaction) with preparation of reaction (1 mM DNA mutation, 1.5μc homophotic first reaction, 0.5μc nucleotide).
The #1 twin was satisfactorily treated and both his brother and sister continued to be in outpatient management with lung function controls and management by gastro-intestinal tract involvement, taking into account the association of the ΔF508/ΔF50 mutation.
