Background Twin-twin transfusion syndrome (TTTS) carries significant morbidity and mortality. In utero, major volume transfer from the “donor” to the “recipient” is associated in the donor with oliguria and activation of the renin-angiotensin system. The recipient is confronted with an exaggerated volume load and paradoxal high levels of renin and angiotensin. This pathological hemodynamic should lead to high blood pressure (BP) in the recipient. However the immediate neonatal BP of these infants is unknown.

Objective Determine the BP in the first 36 hours of life of TTTS infants.

Methods Chart review of all TTTS born in our institution between 1996 to 2007 with selection of pairs for which both twins were alive at least 24 hours (56/110 pregnancies). BP values under amine infusion were excluded.

Results TTTS were delivered at 30.3 +or- 3.2 weeks of gestation. Cardiac biventricular hypertrophy was only present in recipients (36% vs 0). When expressed relative to predicted BP for the weight (Zubrow et al, 1995), both systolic and diastolic BP were significantly higher in recipients (syst/diast: 122+or-26/111+or-26% vs 84+or-13/75+or-18%). Furthermore, the recipients’ BP diminished over the first 12 h of life contrary to the donor and the normal evolution of BP in neonates.

Conclusions Recipients have a significantly high BP and donors a significantly reduced BP for their weight, which supports the hypothesis that recipients are hypertensive in utero. The long-term impact of these early hemodynamic perturbations remains to be determined.