# Twin-to-twin Transfusion Syndrome — GCMD Library living collection Everything in the library about twin-to-twin transfusion syndrome — built automatically from dossiers that name it. Updated: n/a · 3 episodes · 75 cited statements ## Episodes ### Case-Based Learning - [Neonatal Gastric Necrosis: Pediatric Surgery Difficult Cases-Innovative...](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436) — video · 15:51 · [machine version](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436.md) - [Tricks - Neonatal Gastric Necrosis - Sherif Emil](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650) — video · 17:53 · [machine version](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650.md) ### Long-Term Care - [2024 Fetal Care Center Frontiers in Fetal Neurology Day 1 - Hour 2 Q&A](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238) — video · 8:47 · [machine version](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238.md) ## Chapters - [0:00](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=0) Case Presentation: Neonatal Gastric Necrosis (Ep 1) - [2:46](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=166) Initial Surgical Management Discussion (Ep 1) - [4:25](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=265) First Operation and Early Postoperative Course (Ep 1) - [7:45](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=465) Second Operation and Recovery to Reconstruction (Ep 1) - [10:45](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=645) Reconstruction Strategy and Long-term Outcome (Ep 1) - [0:00](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=0) Case presentation: Neonatal gastric necrosis in 27-week twin (Ep 2) - [3:34](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=214) Faculty discussion: Initial surgical management options (Ep 2) - [5:14](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=314) Operative course and complications: Two surgeries and recovery (Ep 2) - [11:31](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=691) Reconstruction planning and Roux-en-Y fundojejunostomy outcome (Ep 2) - [16:12](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=972) Case conclusion and transition to next presenter (Ep 2) - [0:00](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=0) Twin-to-twin transfusion syndrome outcomes after fetoscopic laser surgery (Ep 3) - [3:12](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=192) Palliative care case with cannabis oil use (Ep 3) - [5:18](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=318) Challenges in continuity of care and birth plan implementation (Ep 3) - [8:26](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=506) Closing remarks (Ep 3) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - "Patient was a twin girl born at 27 weeks weighing just over 1 kg with prenatal diagnosis of twin-to-twin transfusion syndrome as the recipient twin" (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=0) - "Laser ablation for TTTS was performed at 22 weeks gestation" (clinical) [Ep 1 · 0:50](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=50) - "Stat C-section performed due to maternal septic shock from E. coli sepsis (initially thought to be amniotic fluid embolus) with premature rupture of membranes, vertically transmitted to both neonates" (clinical) [Ep 1 · 1:10](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=70) - "Apgar scores were 3 at 1 minute and 1 at 5 minutes, patient intubated at birth" (clinical) [Ep 1 · 2:00](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=120) - "On day 3 of life, iatrogenic manipulation of umbilical venous line caused atrial flutter and significant tachycardia with hemodynamic instability requiring cardioversion" (clinical) [Ep 1 · 2:20](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=140) - "At presentation for cardioversion, patient had significant abdominal distention with imaging showing very large amount of free air and unusual shadow in left upper quadrant appearing like loculated free air" (clinical) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=180) - "Operative findings showed longitudinal perforation along greater curvature with entire corpus extending into fundus and cardia necrotic and not holding stitches, with only margin at cardia and couple centimeters of antrum appearing healthy" (clinical) [Ep 1 · 3:40](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=220) - "For subtotal gastric necrosis in unstable neonate, damage control approach should remove frankly necrotic tissue, control upper leakage with tie/vessel loop or drain, and create distal feeding access" — Jack (clinical) [Ep 1 · 3:07](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=187) - "Drain placement for gastric necrosis with unidentifiable proximal extent should be positioned under the liver near the GE junction to drain whatever comes out" — Jack (clinical) [Ep 1 · 3:52](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=232) - "First operation performed damage control: removed necrotic stomach, placed Foley catheter (0.5cc balloon) in distal esophagus, left Penrose drain under left lobe of liver, created ostomy from 2.5cm gastric remnant" (clinical) [Ep 1 · 4:25](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=265) - "Small bowel was like wet toilet paper and multiple hematomas developed in bowel wall from handling, several of which perforated requiring multiple enterorrhaphies" (clinical) [Ep 1 · 5:40](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=340) - "Patient was quite coagulopathic by end of first operation but became hemodynamically stable within 12 hours without pressors and with good urine output" (clinical) [Ep 1 · 6:10](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=370) - "On postoperative day 3, bilious drainage appeared from Penrose drain; on day 4 patient re-distended with difficulty ventilating and imaging showed significant free air again" (clinical) [Ep 1 · 6:50](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=410) - "Second laparotomy revealed no problem with distal esophagus or gastric remnant, but new intestinal perforations: 3cm proximal jejunal necrosis 5cm from ligament of Treitz and spontaneous distal ileal perforation, not at sites of previous repairs" (clinical) [Ep 1 · 7:45](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=465) - "Jejunal necrosis treated with resection and primary anastomosis; ileal perforation debrided and repaired; gastrostomy and esophagostomy tubes left intact" (clinical) [Ep 1 · 8:50](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=530) - "Patient required only CPAP after 7 days of mechanical ventilation despite extreme prematurity" (clinical) [Ep 1 · 9:20](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=560) - "Contrast studies at 2 weeks post-op showed esophagus became like atresic esophagus with segment below diaphragm, no leak around Foley balloon, and esophagus had fibrosed around the catheter" (clinical) [Ep 1 · 9:40](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=580) - "Distal contrast study showed gastric remnant emptied well with healed resections and no stenosis" (clinical) [Ep 1 · 10:20](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=620) - "Initial gastric feeding was limited by gastric capacity at approximately 34cc, with leak around G-tube when larger volumes attempted" (clinical) [Ep 1 · 10:40](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=640) - "Gastroduodenal feeding tube advanced through gastrostomy successfully weaned patient off TPN with all feeds through small intestine plus small amounts of sham feeds suctioned through esophageal tube" (clinical) [Ep 1 · 11:05](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=665) - "For reconstruction with remaining proximal and distal stomach segments, attempting to connect the two stomach ends is reasonable but if unsuccessful a jejunal conduit should be used" — Kathy (opinion) [Ep 1 · 11:44](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=704) - "Salvaging a 4 cubic centimeter stomach would create microgastria with attendant problems of reflux and other issues" (clinical) [Ep 1 · 12:03](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=723) - "Two patients with Hunt-Lawrence pouch (not performed by speaker) had persistent trouble emptying with significant stasis and poor progression" (clinical) [Ep 1 · 12:30](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=750) - "Michigan group published case report of microgastria treated with Roux-en-Y esophago-fundojejunostomy similar to adult gastric cancer surgery" (host_summary) [Ep 1 · 13:00](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=780) - "Pre-reconstruction contrast study showed small gastric segment remaining with esophagus distending nicely without strictures" (clinical) [Ep 1 · 13:30](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=810) - "Reconstruction performed at 5 months of age, 55 weeks post-conception age, weight 5kg, using Roux-en-Y fundojejunostomy with segment 15cm distal to ligament of Treitz and 25cm limb" (clinical) [Ep 1 · 14:00](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=840) - "Post-reconstruction contrast study on postoperative day 6 showed good emptying, allowing start of combination oral and gastrostomy feeds" (clinical) [Ep 1 · 14:40](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=880) - "Patient discharged 52 days after reconstruction with total hospital stay of 207 days" (clinical) [Ep 1 · 15:05](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=905) - "At 2.5 years old, patient takes normal diet for age on full oral feeds with only nighttime gastrostomy supplementation anticipated to be discontinued early in new year, and is larger than unaffected twin" (clinical) [Ep 1 · 15:20](https://library.globalcastmd.com/watch/neonatal-gastric-necrosis-pediatric-surgery-difficult-cases-innovative-436?t=920) - "Patient was a twin girl born at 27 weeks weighing just over 1 kg with prenatal diagnosis of twin-to-twin transfusion syndrome (recipient twin)" — Sherif Emil (clinical) [Ep 2 · 0:48](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=48) - "Twin-to-twin transfusion ablation was performed at 22 weeks gestation" — Sherif Emil (clinical) [Ep 2 · 1:20](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=80) - "Stat C-section performed due to maternal septic shock from E. coli sepsis (initially thought to be amniotic fluid embolus), vertically transmitted to both neonates" — Sherif Emil (clinical) [Ep 2 · 1:35](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=95) - "Apgar scores were 3 at 1 minute and 1 at 5 minutes; patient intubated at birth" — Sherif Emil (clinical) [Ep 2 · 2:10](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=130) - "On day 3, iatrogenic manipulation of umbilical venous line caused atrial flutter and significant tachycardia with hemodynamic instability requiring cardioversion" — Sherif Emil (clinical) [Ep 2 · 2:25](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=145) - "At presentation for cardioversion, patient had significant abdominal distention with large amount of free air on imaging, including unusual shadow in left upper quadrant appearing like loculated free air" — Sherif Emil (clinical) [Ep 2 · 2:55](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=175) - "Intraoperative findings: longitudinal perforation along greater curvature with entire corpus and fundus/cardia necrotic, not holding stitches, with only couple centimeters of good antrum remaining" — Sherif Emil (clinical) [Ep 2 · 3:25](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=205) - "For subtotal gastric necrosis in unstable 1-kg neonate, damage control approach includes removing necrotic tissue, controlling proximal extent with tie or vessel loop, stapling or sewing distal end, placing feeding jejunostomy, and leaving drain near GE junction" — Jack (clinical) [Ep 2 · 4:29](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=269) - "First operation: removed necrotic stomach, placed Foley catheter (0.5cc balloon) up distal esophagus, left Penrose drain under left lobe of liver, created ostomy tube from 2.5cm gastric remnant" — Sherif Emil (clinical) [Ep 2 · 5:14](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=314) - "Small bowel was like wet toilet paper; multiple hematomas developed in wall from handling, several perforated requiring multiple enterorrhaphies" — Sherif Emil (clinical) [Ep 2 · 6:20](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=380) - "Patient was coagulopathic by end of first operation but became hemodynamically stable within 12 hours without pressors and with good urine output" — Sherif Emil (clinical) [Ep 2 · 6:50](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=410) - "On post-op day 3, bilious drainage appeared from Penrose drain; on day 4, patient distended and became difficult to ventilate with large amount of free air on imaging" — Sherif Emil (clinical) [Ep 2 · 7:25](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=445) - "Second laparotomy findings: no problem with distal esophagus or gastric remnant, but new intestinal perforations at different sites than previous repairs" — Sherif Emil (clinical) [Ep 2 · 7:55](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=475) - "Second operation addressed 3cm proximal jejunal necrosis 5cm from ligament of Treitz (resection and primary anastomosis) and spontaneous distal ileal perforation (debridement and repair)" — Sherif Emil (clinical) [Ep 2 · 8:30](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=510) - "Patient required only CPAP after 7 days of mechanical ventilation despite prematurity" — Sherif Emil (clinical) [Ep 2 · 9:10](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=550) - "At 2 weeks post-op, contrast studies showed esophagus became like atresic esophagus with segment below diaphragm; no leak around Foley balloon as esophagus had fibrosed around catheter" — Sherif Emil (clinical) [Ep 2 · 9:30](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=570) - "Distal contrast study through gastric remnant showed all resections healed without stenosis, with contrast traversing bowel in short period" — Sherif Emil (clinical) [Ep 2 · 10:10](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=610) - "Initial gastric remnant feeding limited by capacity (maximum 34cc); leak around G-tube occurred with larger volumes and poor pyloric emptying" — Sherif Emil (clinical) [Ep 2 · 10:40](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=640) - "Gastroduodenal feeding tube advanced through gastrostomy under fluoroscopy successfully weaned patient off TPN; small amounts of sham feeds given orally and suctioned through esophageal tube" — Sherif Emil (clinical) [Ep 2 · 11:10](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=670) - "Salvaging remaining 1cm of cardia to create 4 cubic centimeter stomach would result in microgastria with attendant reflux and other problems" — Sherif Emil (opinion) [Ep 2 · 12:32](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=752) - "Hunt-Lawrence pouch has been described for microgastria but in speaker's experience with two patients, they had trouble emptying with significant stasis and poor progression" — Sherif Emil (opinion) [Ep 2 · 13:00](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=780) - "Michigan group published case report of microgastria treated with Roux-en-Y esophago-fundojejunostomy (approach used for adult gastric cancer)" — Sherif Emil (clinical) [Ep 2 · 13:30](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=810) - "Pre-reconstruction contrast study showed small gastric segment remaining with esophagus distending nicely without strictures" — Sherif Emil (clinical) [Ep 2 · 14:00](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=840) - "Reconstruction performed at 5 months of age (55 weeks post-conception age, 5kg weight) using Roux-en-Y fundojejunostomy with segment 15cm distal to ligament of Treitz and 25cm limb" — Sherif Emil (clinical) [Ep 2 · 14:25](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=865) - "Post-op day 6 contrast study through esophagus showed good emptying; combination oral and gastrostomy feeds started" — Sherif Emil (clinical) [Ep 2 · 15:10](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=910) - "Patient discharged 52 days after reconstruction with total hospital stay of 207 days" — Sherif Emil (clinical) [Ep 2 · 15:35](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=935) - "At 2.5 years old, patient takes normal diet for age on full oral feeds with nighttime gastrostomy supplementation (anticipated to discontinue early in new year), and is bigger than unaffected twin" — Sherif Emil (clinical) [Ep 2 · 15:55](https://library.globalcastmd.com/watch/tricks-neonatal-gastric-necrosis-sherif-emil-650?t=955) - "Most imaging studies reported in twin-to-twin transfusion are ultrasound-based, reporting in a meta-analysis a 2% rate of intracranial abnormalities (whether acquired acute injury, remote injury, or malformation secondary to remote injury)." — Gano (epidemiological) [Ep 3 · 0:29](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=29) - "Higher rates of brain injury are seen by MRI both in fetal MRI studies and studies of neonatal neuroimaging following a complicated twin pregnancy compared to ultrasound-based reporting." — Gano (epidemiological) [Ep 3 · 0:29](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=29) - "Rates of brain injury after amnio reduction range from 6 to 38%." — Gano (epidemiological) [Ep 3 · 0:29](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=29) - "After laser surgery for twin-to-twin transfusion, the estimated range of brain injury by MRI is about 8 to 18%." — Gano (epidemiological) [Ep 3 · 0:29](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=29) - "Rates of cerebral palsy after laser surgery for twin-to-twin transfusion vary from about 3 to 12%." — Gano (epidemiological) [Ep 3 · 0:29](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=29) - "Any neurodevelopmental impairment after laser surgery for twin-to-twin transfusion occurs in up to about 20% of cases." — Gano (epidemiological) [Ep 3 · 0:29](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=29) - "After treatment with fetal laser surgery for twin-to-twin transfusion, about two-thirds have survival with no early neurodevelopmental impairment." — Gano (epidemiological) [Ep 3 · 0:29](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=29) - "There is ongoing risk for brain injury even after laser surgery for twin-to-twin transfusion because there could be reanastomosis or co-twin demise." — Gano (clinical) [Ep 3 · 0:29](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=29) - "There is an inverse relationship between risk of brain injury and gestational age at birth in twin-to-twin transfusion cases." — Gano (clinical) [Ep 3 · 0:29](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=29) - "Charlotte's Web is a cannabis oil that families buy over the counter." — Agarwal (clinical) [Ep 3 · 3:29](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=209) - "Neurologists do not recommend over-the-counter cannabis oils." — Agarwal (opinion) [Ep 3 · 3:29](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=209) - "When counseling patients with severe abnormalities (genetic or structural), there is a tendency to focus on the risk of death, but clinicians must also prepare families for the chance of survival and what that looks like both short-term and long-term." (opinion) [Ep 3 · 4:17](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=257) - "Parent decision-making evolves after seeing the child and cannot be determined solely by discussions at 24 weeks, 36 weeks, or even at the time of birth." — Agarwal (clinical) [Ep 3 · 4:45](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=285) - "Hard conversations about care decisions need to be repeated again and again as parents see how the child is doing in the days or weeks after birth." — Agarwal (clinical) [Ep 3 · 4:45](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=285) - "Child neurologists meeting families prenatally do not have an established relationship, making it challenging to convey information." (opinion) [Ep 3 · 5:18](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=318) - "Following families through their neonatal period, postnatal period, and sometimes into adulthood is incredibly rewarding but not always possible at many centers." (opinion) [Ep 3 · 5:18](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=318) - "Studies have shown that while many families have been pleased with their fetal experience, they struggle once they enter the NICU and beyond, feeling like they have lost their support system." (epidemiological) [Ep 3 · 5:18](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=318) - "Writing a note in the electronic medical record with all details of medical care that aligns with the birth plan is helpful for continuity of care." — Cortezo (clinical) [Ep 3 · 6:56](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=416) - "Even with the same Epic system, electronic medical records do not all communicate with each other, requiring providers to manually route notes to obstetricians." — Cortezo (clinical) [Ep 3 · 6:56](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=416) - "Ensuring continuity of care through birth plans is labor intensive and by no means foolproof." — Cortezo (opinion) [Ep 3 · 6:56](https://library.globalcastmd.com/watch/2024-fetal-care-center-frontiers-in-fetal-neurology-day-1-hour-2-q-a-9238?t=416) ## Changelog - Sep 25: 3 items added automatically --- Educational content from recorded physician discussions — not medical advice. 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