All for one and one delivery room approach for all?

Autumn Kiefer, Julie Johnson Rolfes, Greg Barretto, John D. Lantos

Research output: Contribution to journalArticlepeer-review


Multiple births are increasing in frequency related to advanced maternal age and fertility treatments, and they have an increased risk for congenital anomalies compared to singleton births. However, twins have the same congenital anomalies <15% of the time. Thus, having multiple births with discordant anomalies is a growing challenge for neonatologists. Although external anomalies can often be spotted quickly at delivery or sex differences between multiples can rapidly identify those with internal anomalies described on prenatal ultrasound, we present a case of male multiples, who would optimally receive different initial resuscitation strategies on the basis of the presence or absence of an internal anomaly. The similar size of 4 extremely preterm quadruplets raises concern for whether accurate, immediate identification of 1 neonate with a congenital diaphragmatic hernia will be reliable in the delivery room. Clinicians discuss the ethical considerations of an "all for one" approach to this resuscitation.

Original languageEnglish (US)
Article numbere20192704
Issue number5
StatePublished - May 2020

Bibliographical note

Publisher Copyright:
© 2020 by the American Academy of Pediatrics


  • Cesarean Section/ethics
  • Delivery Rooms/ethics
  • Delivery, Obstetric/ethics
  • Female
  • Fetal Membranes, Premature Rupture/diagnosis
  • Humans
  • Infant, Extremely Premature/physiology
  • Infant, Newborn
  • Intubation, Intratracheal/ethics
  • Pregnancy
  • Pregnancy, Quadruplet/physiology

PubMed: MeSH publication types

  • Case Reports
  • Letter


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