
Enrico LoprioreLeiden University Medical Centre | LUMC · Department of Pediatrics
Enrico Lopriore
Professor
About
529
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Introduction
Publications
Publications (529)
Background and Clinical Significance: Ultrasonographic diagnosis of twin pregnancies has become routine, with chorionicity playing a crucial role in assessing associated risks. Traditionally, monochorionic (MC) twins were believed to derive from a single zygote, ensuring sex concordance. However, recent cases of dizygotic monochorionic (MCDZ) twins...
Objective
Fetomaternal transfusion (FMT) is associated with increased perinatal mortality and morbidity, but data on postnatal outcomes are scarce. Our aim was to determine the incidence of adverse short-term
and long-term sequelae of severe FMT.
Design
Retrospective cohort study.
Setting
Dutch tertiary neonatal intensive care unit.
Patients
Liv...
Objective
To describe the use and nationwide variation of red blood cell (RBC) transfusions in neonatal intensive care units (NICUs) following the introduction of the revised national transfusion guideline in 2019.
Design and patients
We randomly selected neonates born below 32 weeks’ gestation admitted to any NICU in the Netherlands in 2020 to in...
Importance
Preventive efforts in pregnancy-related alloimmunization have considerably decreased the prevalence of hemolytic disease of the fetus and newborn (HDFN). International studies are therefore essential to obtain a deeper understanding of the postnatal management and outcomes of HDFN. Taken together with numerous treatment options, large pr...
Monochorionic twin pregnancies are a subset of twin pregnancies that face potential complications related to a shared circulation between the fetuses. These complications are related to anastomotic placental vessels connecting the cardiovascular systems of the two fetuses, which can result in significant sequela if one twin experiences intrauterine...
Background and Objectives
Foetal and neonatal alloimmune thrombocytopenia (FNAIT) results from maternal platelet‐directed antibodies and can result in severe intracranial haemorrhage (ICH) in foetuses and newborns. Screening for human platelet antigen‐1a (HPA‐1a)‐directed antibodies during pregnancy could allow timely intervention with antenatal tr...
Background
Physiological-based cord clamping (PBCC) in preterm infants is beneficial for cardiovascular transition at birth and may optimize placental transfusion. Whether PBCC can improve clinical outcomes is unknown. The aim of the Aeration, Breathing, Clamping (ABC3) trial was to test whether PBCC results in improved intact survival in very pret...
Complexity science is a discipline which explores how complex systems behave and how we interact with them. Though it is widely implemented outside medicine, particularly in the sciences involving human behavior, but also in the natural sciences such as physics and biology, there are only a few applications within medical research. We propose that...
Background and Objectives
Routine coagulation screens at birth are still standard in some European neonatal intensive care units (NICUs), although interpretation of these results is complex in preterm infants. It is unclear to what extent local coagulation assay results agree with published reference ranges when using different analysers and reagen...
Introduction:
This study aimed to describe the prevalence and risk factors for respiratory complications in monochorionic twins with twin anaemia polycythaemia sequence (TAPS).
Methods:
All neonates diagnosed with postnatal TAPS at our center between 2002 and 2023 were included in this retrospective study. The primary outcome was the prevalence...
Aim
In this article, we present two cases of severe fetal hemolytic anemia based on a beta‐thalassaemia trait inherited from a single parent.
Results
These cases, presented at 20 and 28 weeks' gestation, necessitated intra‐uterine blood transfusions. This occurrence is remarkable because it challenges the common assumption that beta‐thalassaemia t...
Background
Platelet transfusions are given to preterm infants with severe thrombocytopenia aiming to prevent haemorrhage. The PlaNeT2/MATISSE trial revealed higher rates of mortality and/or major bleeding in preterm infants receiving prophylactic platelet transfusions at a platelet count threshold of 50 × 10⁹/L compared to 25 × 10⁹/L. The extent to...
Background
Thrombocytopenia, common in preterm newborns, may increase bleeding risk and is often treated with transfusions. Recent studies reveal that transfusing platelets at a high threshold worsens outcomes, possibly due to a “developmental mismatch” between adult‐derived platelets and neonatal hemostatic system. Cord blood‐derived platelet conc...
Importance
Red blood cell (RBC) transfusions are frequently administered to preterm infants born before 32 weeks of gestation in the neonatal intensive care unit (NICU). Two randomized clinical trials (Effects of Transfusion Thresholds on Neurocognitive Outcomes of Extremely Low-Birth-Weight Infants [ETTNO] and Transfusion of Prematures [TOP]) foun...
Purpose
To determine the independent effect of uteroplacental malperfusion on the development of retinopathy of prematurity (ROP).
Methods
This cohort study included 591 neonates with a gestational age (GA) ≤ 32 weeks or birthweight (BW) ≤ 1500 g. Clinical data was retrospectively collected and placentas were prospectively examined for maternal va...
Objective Nipocalimab is a neonatal fragment crystallizable (Fc) receptor (FcRn)—blocking monoclonal antibody that inhibits placental immunoglobulin G (IgG) transfer and lowers circulating maternal IgG levels. In an open-label, single-arm, phase 2 study, nipocalimab demonstrated evidence of safety and efficacy that support further investigation in...
Background:
The timing of cord clamping has become a focal point for neonatal caregivers due to the promising outcomes associated with delayed cord clamping, which is a simple and cost-effective method to enhance the survival and well-being of preterm infants. While initially the rationale behind delaying clamping was to facilitate increased place...
Introduction
Selective fetal growth restriction (sFGR) in monochorionic twin pregnancy, defined as an estimated fetal weight (EFW) of one twin <10th centile and EFW discordance ≥25%, is associated with stillbirth and neurodisability for both twins. The condition poses unique management difficulties: on the one hand, continuation of the pregnancy ca...
Background:
In early-onset severe hemolytic disease of the fetus and newborn (HDFN), transplacental transfer of maternal antierythrocyte IgG alloantibodies causes fetal anemia that leads to the use of high-risk intrauterine transfusions in order to avoid fetal hydrops and fetal death. Nipocalimab, an anti-neonatal Fc receptor blocker, inhibits tra...
Objective Neonatal sepsis has been established as a risk factor for retinopathy of prematurity (ROP) but previous meta-analyses have predominately focused on late-onset sepsis (LOS). This meta-analysis aims to explore the association between early-onset sepsis (EOS) and the risk of ROP.
Study Design Observational studies reporting (unadjusted) data...
Objective
To describe the incidence of major bleeds according to different platelet counts in very preterm infants, and to explore whether this association is influenced by other risk factors for bleeding.
Design
Observational cohort study.
Setting
A Dutch tertiary care neonatal intensive care unit.
Patients
All consecutive infants with a gestat...
Objective
To identify current practices in the management of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancies.
Design
Cross‐sectional survey.
Setting
International.
Population
Clinicians involved in the management of MCDA twin pregnancies with sFGR.
Methods
A structured, self‐administered survey.
Ma...
The human umbilical cord (hUC) is the lifeline that connects the fetus to the mother. Hypercoiling of the hUC is associated with pre- and perinatal morbidity and mortality. We investigated the origin of hUC hypercoiling using state-of-the-art imaging and omics approaches. Macroscopic inspection of the hUC revealed the helices to originate from the...
Background and Objectives
To evaluate the severity of haemolytic disease of the foetus and newborn (HDFN) in subsequent pregnancies with RhD immunization and to identify predictive factors for severe disease.
Materials and Methods
Nationwide prospective cohort study, including all pregnant women with RhD antibodies. All women with at least two pre...
Background
Fetal growth restriction (FGR) can negatively affect lung development, leading to increased respiratory morbidity and reduced lung function later in life. Studies regarding the impact of FGR on lung function in singletons are influenced by genetic, obstetric, and maternal factors. To overcome these confounding factors, we aim to investig...
Thrombocytopenia (defined as a platelet count <150×109/L) is a common condition in preterm neonates and may occur in 18-35% of all infants admitted to the Neonatal Intensive Care Unit (NICU). Neonatal platelet functionality in terms of reactivity is often described as reduced compared to adults, even in healthy, term neonates. However, this platele...
Background
Mortality, cerebral injury, and necrotizing enterocolitis (NEC) are common complications of very preterm birth. An important risk factor for these complications is hemodynamic instability. Pre-clinical studies suggest that the timing of umbilical cord clamping affects hemodynamic stability during transition. Standard care is time-based c...
Objective The role of placental inflammation in neonatal morbidities is underestimated due to lack of placental examination. This meta-analysis aims to assess the association between histological chorioamnionitis (HCA) with and without funisitis (FUN) and risk of retinopathy of prematurity (ROP).
Study Design Forty-five studies reporting (unadjuste...
The distinct placental angioarchitecture in monochorionic (MC) pregnancies increases the risk of complications such as twin–twin transfusion syndrome (TTTS), twin anemia polycythemia sequence (TAPS), and selective fetal growth restriction (sFGR). The aim of this systematic review was to evaluate the incidence, type, and severity of cerebral injury...
Background
Advances in postnatal care for hemolytic disease of the fetus and newborn (HDFN) have occurred over the past decades, but little is known regarding the frequency of postnatal treatment and the clinical outcomes of affected neonates. Most studies reporting on HDFN originate from high-income countries or relatively large centers, but impor...
Objective
Pregnant women who received at least one intrauterine transfusion (IUT) for haemolytic disease of the fetus and newborn (HDFN) in the preceding pregnancy are presumed to have a high likelihood of requiring IUTs again, often starting at an earlier gestational age. Our aim was to quantify these risks in a large national cohort.
Design
Retr...
Objective
Research suggests that postnatal catch-up growth after fetal growth restriction (FGR) occurs frequently. Yet, postnatal growth in singletons may be influenced by multiple factors. Identical twins with discordant prenatal growth, termed selective FGR (sFGR), can be regarded as a natural experiment eliminating these sources of bias.
Design...
Background aims:
Human umbilical cord-derived mesenchymal stromal cells (hUC-MSCs) are increasingly used in research and therapy. To obtain hUC-MSCs, a diversity of isolation and expansion methods are applied. Here, we report on a robust and standardized method for hUC-MSC isolation and expansion.
Methods:
Using 90 hUC donors, we compared and op...
Introduction:
Perforation of the intertwin membrane can occur as a complication of fetoscopic laser surgery for twin-twin transfusion syndrome (TTTS). Data on the occurrence and the risk of subsequent cord entanglement is limited. The objective of this study is to assess the prevalence, risk factors and outcome of intertwin membrane perforation an...
Background:
Research in singletons identified fetal growth restriction (FGR) as a risk factor for retinopathy of prematurity (ROP), but is generally subject to confounding by genetic, obstetric, and maternal factors. We investigated the effect of FGR on ROP in growth-discordant identical twins, thereby controlling for confounding factors.
Methods...
Objective:
To assess perinatal outcome after fetal reduction in complicated monochorionic (MC) twin pregnancies comparing different techniques.
Methods:
A retrospective cohort study at a national referral center, comparing data between four techniques: interstitial laser coagulation (ILC), radiofrequency ablation (RFA), fetoscopic laser coagulat...
Introduction:
The purpose of this study was to evaluate the within-pair difference in retinopathy of prematurity (ROP) between donors and recipients with twin-to-twin transfusion syndrome (TTTS) and to identify risk factors for ROP development.
Methods:
This retrospective cohort study included 147 TTTS twin pairs managed between 2002-2022 and el...
Objective:
To evaluate the neurodevelopmental outcome at school age in children newly diagnosed with fetal neonatal alloimmune thrombocytopenia (FNAIT).
Study design:
This observational cohort study included children diagnosed with FNAIT between 2002 and 2014. Children were invited for cognitive and neurological testing. Behavioral questionnaire...
Abstract
Objective Assess mortality and neurodevelopmental outcomes at 2 years of corrected age in children who participated in the PlaNeT-2/MATISSE (Platelets for Neonatal Transfusion - 2/Management of Thrombocytopenia in Special Subgroup) study, which reported that a higher platelet transfusion threshold was associated with significantly increase...
Background
Hand hygiene (HH) is the most critical measure in the prevention of nosocomial infections in the neonatal intensive care unit (NICU). Improving and sustaining adequate HH compliance rates, however, remains a significant challenge. Using a behavioral change framework and nudge theory, we developed a design-based concept aimed at facilitat...
Background
Preterm infants commonly receive red blood cell (RBC), platelet and fresh frozen plasma (FFP) transfusions. The aim of this Neonatal Transfusion Network survey was to describe current transfusion practices in Europe and to compare our findings to three recent randomised controlled trials to understand how clinical practice relates to the...
Introduction
Monochorionic twins may develop fetal anemia when blood is unequally distributed via the placental vascular anastomoses. This review focusses on the causes of fetal anemia in complicated monochorionic twins and highlights the differences in management and outcome.
Areas covered
Fetal anemia can occur in the context of twin anemia poly...
Objective
To compare the effect of two different automated oxygen control devices on time preterm infants spent in different oxygen saturation (SpO 2 ) ranges during their entire stay in the neonatal intensive care unit (NICU).
Design
Retrospective cohort study of prospectively collected data.
Setting
Tertiary level neonatal unit in the Netherlan...
Background:
In critically ill (preterm) neonates, catheter-related venous thromboembolism (CVTE) can be a life-threatening complication. Evidence on optimal management in the literature is lacking. In the Netherlands, a consensus-based national management guideline was developed to create uniform CVTE management.
Objectives:
To evaluate the effi...
Objective: Fetal and neonatal alloimmune thrombocytopenia (FNAIT) results from maternal platelet-directed antibodies which can cause severe intracranial haemorrhage (ICH) in fetuses and new-borns. Screening for human platelet antigen-1a (HPA-1a) directed antibodies during pregnancy could allow for timely intervention with antenatal treatment and pr...
Since the discovery of the Rh blood group system in 1940, a greater understanding of hemolytic disease of the fetus and newborn (HDFN) was gained. In the years thereafter, researchers and clinicians came to the current understanding that fetal and neonatal red blood cells (RBC) are hemolyzed by maternal alloantibodies directed against RBC antigens...
Background:
Among neonates with hemolytic disease of the fetus and newborn (HDFN), we aimed to describe the frequency of central-line use, indications for insertion, and incidence of confirmed and suspected sepsis, including antibiotic treatment over a 10-year surveillance period.
Study design and methods:
All neonates with HDFN admitted to our...
Introduction
Hemolytic disease of the fetus and newborn (HDFN) is a condition caused by maternal alloantibodies against fetal red blood cells (RBCs) that can cause severe morbidity and mortality in the fetus and newborn. Adequate screening programs allow for timely prevention and intervention resulting in significant reduction of the disease over t...
Background:
Plasma is a commonly used blood product and is available in the form of fresh frozen plasma (FFP) or pooled solvent/detergent-treated plasma. In the Netherlands, solvent/detergent-treated plasma has become the standard product in the adult population since several years, but for neonatal use, FFP remains the product of preference.
Des...
Background
International guidelines recommend delayed umbilical cord clamping (DCC) up to 1 min in preterm infants, unless the condition of the infant requires immediate resuscitation. However, clamping the cord prior to lung aeration may severely limit circulatory adaptation resulting in a reduction in cardiac output and hypoxia. Delaying cord cla...
Nosocomial bloodstream infections (NBSIs), commonly due to central-line associated bloodstream infections (CLABSI), contribute substantially to neonatal morbidity and mortality. We aimed to identify longitudinal changes in incidence of NBSI, microbiological-spectrum, and antibiotic exposure in a large cohort of preterm neonates admitted to the neon...
Background
Children affected by fetal and neonatal alloimmune thrombocytopenia (FNAIT) are at risk of severe intracranial haemorrhage. Management in the postnatal period is based on sparse evidence. We aimed to describe the contemporary management and outcomes of patients with FNAIT in high-income countries.
Methods
In this multicentre, retrospect...
Background
Psychosocial development in monochorionic (MC) twins born after selective fetal growth restriction (sFGR) has been unreported to date, despite its importance for daily functioning and future relationships.
Aims
To investigate psychosocial development, attachment and school functioning in monochorionic twins with selective fetal growth r...
This systematic review aims to assess the gestational age at birth and perinatal outcome (intrauterine demise (IUD), neonatal mortality and severe cerebral injury) in monochorionic (MC) twins with selective fetal growth restriction (sFGR), according to Gratacós classification based on umbilical artery Doppler flow patterns in the smaller twin. Seve...
Background
Singletons born after fetal growth restriction (FGR) are at increased risk of poor neurodevelopmental outcomes. Studies of singletons with FGR usually compare outcomes with those without FGR, a comparison that is inherently biased by obstetrical, parental, and genetic factors. We aim to compare neurodevelopmental outcomes between the sma...
Background
In monochorionic twin pregnancies the fetuses share a single placenta. When this placenta is unequally shared, a discordant antenatal growth pattern ensues resulting in high rates of perinatal morbidity and mortality. Understanding of placental pathophysiology is paramount in devising feasible antenatal management strategies. Unequal pla...
Background
Children with fetal and neonatal alloimmune thrombocytopenia (FNAIT) face increased risk of intracranial hemorrhage (ICH) potentially leading to developmental impairment. To prevent ICH, pregnant women with alloantibodies against fetal platelets are often treated with intravenous immunoglobulin (IVIg). IVIg appears effective in vastly re...
Objective
In response to the increasing focus on family-centred care, neonatal intensive care unit (NICU) environments have gradually shifted towards the single-room design. However, the assumed benefits of this emerging design remain a subject of debate. Our goal was to evaluate the impact of single-room versus open-bay care on the risk of neonata...