Eight-month-old twins from Hayward Heath, West Sussex, recently met the surgeon who saved their lives even before they were born. The BBC reports how their mother, Katerina Ahouansou, at six months pregnant, during a routine scan, uncovered a serious issue with their development and blood supply.

Doctors diagnosed the twins with twin-to-twin transfusion syndrome or TTTS. It is a condition where one twin received more blood and nourishment than the other due to uneven blood vessel distribution in the placenta. In case there is no medical intervention, it could be fatal for both the twins.

A Specialist Steps In

This is when Ahouansou was referred to Professor Kypros Nicolaides at King’s College Hospital in London. Professor Nicolaides is a pioneer in fetal medicine and he specializes in a laser procedure that redistributes blood supply between twins in cases of TTTS.

When Ahouansou was scanned, Nicolaides observed that one of the twins were significantly smaller than the other. "There was a very high chance that if we did not intervene, both twins could die," he recalled.

An Operation No Less Than A Miracle

The life-saving laser surgery was performed and within a week the doctors saw an improvement with the twin who was smaller in size. When the twins were born, they weighed 1.5kg and 1.7kg. To recognize the efforts by the surgeon, Ahouansou named them Kai Kypros and Asher Nicolas after Professor Kypros Nicolaides.

Ahouansou also expressed deep gratitude for the professor's expertise and called him "proof that miracles can be performed by people who are devotees to their profession."

Professor Kypros Nicolaides has been at King’s College Hospital since 1980 and is widely regarded as a leader in fetal medicine. His groundbreaking research and development of screening and surgical techniques have saved countless lives.

Through his dedication, Professor Nicolaides has given many families hope, demonstrating how medical advancements continue to improve survival rates for complex fetal conditions like TTTS.

More about Twin-to-twin Transfusion Syndrome

As per the John Hopkins Medicine, TTTS is a rare pregnancy condition that affects identical twins or other multiples. It happens in pregnancies where twins share one placenta and a network of blood vessels that supply oxygen and nutrients essential for development in the womb. These pregnancies are known as monochorionic.

Sometimes, the blood vessels in the placenta are unevenly distributed, causing an imbalance in blood flow between the twins. The donor twin loses more blood than it receives, leading to malnutrition and potential organ failure. Meanwhile, the recipient twin gets an excess of blood, putting strain on the heart and increasing the risk of cardiac complications.

Impact on the Donor Twin

The donor twin loses blood volume (hypovolemia), reducing kidney function and urine production. This leads to low amniotic fluid levels (oligohydramnios) or, in severe cases, a complete absence (anhydramnios). Without proper blood circulation, the donor twin faces cardiovascular issues, increasing the risk of death.

Impact on the Recipient Twin

The recipient twin experiences excess blood volume (hypervolemia), causing increased urination and excessive amniotic fluid (polyhydramnios). The overworked heart struggles to handle the surplus blood, leading to cardiovascular dysfunction, heart failure, and, in extreme cases, death.

Amid rising obesity, early diabetes risk, and mental health issues among children, India has expanded its child health screening program to include behavioral disorders and non-communicable disease (NCD) risk factors.

The Ministry of Health and Family Welfare rolled out the screening measures under the revised Rashtriya Bal Swasthya Karyakram (RBSK) 2.0 guidelines.

The guidelines include steps to address mental health conditions and early risk factors for diseases such as diabetes and hypertension. These were released at the recently concluded National Summit on Good Practices and Innovations in Public Healthcare Service Delivery.

The screening services are free and will be delivered through mobile health teams at Anganwadi centers and schools, ensuring universal outreach and early identification.

What Does The RBSK 2.0 Guideline Include?

• The guidance document establishes, for the first time, a structured and standardized national framework for the screening, diagnosis, treatment, and long-term management of childhood diabetes. It calls for universal screening of all children from birth to 18 years.

• Suspected cases will undergo immediate blood glucose testing and timely referral to district-level health facilities for confirmatory diagnosis and treatment.

• A free-of-cost care package will be available at public health facilities. This includes screening, diagnostic services, lifelong insulin therapy, monitoring devices such as glucometers and test strips, and regular follow-up care. This will reduce the financial burden and ensure uninterrupted treatment for children diagnosed with diabetes.

• The initiative promotes the “4Ts” awareness framework—Toilet, Thirsty, Tired, and Thinner—enabling parents, teachers, and caregivers to recognize early warning signs of Type 1 diabetes.

• The document also emphasizes the need to provide structured training on insulin administration, blood glucose monitoring, emergency response, and daily disease management. It outlines evidence-based treatment guidelines, regular monitoring schedules, and protocols for preventing complications.

• RBSK 2.0 introduces digital health cards, real-time data systems, and integrated platforms for tracking, monitoring, and service delivery. These digital innovations are expected to enhance program efficiency, accountability, and evidence-based decision-making across all levels of implementation.

Signs Of Diabetes In Children

Children with Type 1 Diabetes Mellitus can develop diabetic ketoacidosis (DKA) if it is not diagnosed on time, since they are insulin-dependent.

Dr. Archana Arya, Senior Consultant Pediatric & Adolescent Endocrinologist at the Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, told HealthandMe that DKA requires hospitalization for treatment, and if undiagnosed, it can lead to coma and death. Early diagnosis reduces morbidity and hospital admissions.

These children present with typical symptoms such as

• increased thirst,
• frequent urination,
• weight loss.

Type 2 Diabetes Mellitus may or may not present with typical symptoms, and children may develop long-term complications such as retinopathy and nephropathy if the condition goes undiagnosed for a prolonged period.

All overweight and obese children, especially those with a family history of Type 2 diabetes, those with acanthosis nigricans (thickened and dark skin behind the neck and underarms), and girls with PCOS are at high risk of developing Type 2 diabetes and should be screened annually to prevent complications.

The expert added that children with diabetes are at a higher risk of depression (2–3 times higher prevalence), anxiety, and suicidal ideation (in 8–27 percent of youth) due to dietary restrictions and the burden of multiple insulin injections in Type 1 diabetes. Diabetic youth are 1.7 times more likely to attempt suicide, often through insulin overdose.

Why Is The Initiative Important?

Dr. Seema Dhir, Unit Head & Senior Consultant, Internal Medicine, Artemis Hospitals, told HealthandMe that good health in early life is essential for preventing non-communicable diseases such as obesity, diabetes, and heart disease. Diabetes is often linked to poor lifestyle and health choices.

Early monitoring, detection, and effective management can reduce the growing burden of diabetes.

Dr. Munia Bhattacharya, Senior Consultant – Clinical Psychology, Mental Health and Behavioural Sciences, Marengo Asia Hospitals, Gurugram, emphasized that preventing non-communicable diseases like diabetes, heart disease, and obesity begins with maintaining both mental and physical well-being.

Providing mental support to children helps them cope better with stress and reduces the risk of anxiety, depression, and suicidal thoughts.

Children who are encouraged to express their feelings and seek help are less likely to experience anxiety, depression, and suicidal tendencies. Early awareness also builds coping skills, decision-making abilities, and healthier lifestyles—paving the way for long-term well-being and a more balanced, confident future.

Babies exposed to pollution, especially vehicle exhaust, during the first trimester of pregnancy had worse language skills at 18 months, according to a study.

The research, published in the Journal of Physiology, found that children exposed to traffic emissions have different brain structure sizes, attributed to pollution exposure in the womb.

Notably, pollution had an even greater impact on babies born pre-term, with this group showing poorer motor as well as language skills.

“We wanted to establish if air pollution levels related to cognitive, language, and motor abilities in this critical period of early childhood. The first 1,000 days from conception to age two shape long-term brain health and behavior,” said lead author Dr Alexandra Bonthrone, from King’s College London.

What Did The Study Find?

The team involved 498 infants from Greater London between 2015 and 2020. Of the cohort, 125 were born prematurely, and within that group, 54 were born less than 32 weeks – known as ‘very and extremely preterm’.

Analyzing pollutants like particulate matter and nitrogen dioxide, which are emitted by traffic exhaust, the researchers estimated the amount of pollution mothers were exposed to during pregnancy based on their home postcode.

The infants underwent a standard clinical test of development, known as the Bayley Scales, which measures cognitive, language, and motor skills, with scores of 100 reflecting the population average.

Those exposed to high pollution in the first trimester of pregnancy scored on average 5-7 points lower compared to babies exposed to low pollution on language tests. There was no association with pollution in the second and third trimesters.

Premature babies exposed to the highest pollution levels in the womb across all of pregnancy scored on average 11 points less than those exposed to low levels for motor skills.

How Pollution Impacts Fetal Health

Breathing in air pollution is the second largest risk factor for death in children under 5 globally, second only to malnutrition, according to the State of Global Air Report.

According to experts, maternal exposure to pollution increases the risk of miscarriage, pre-term births, stillbirths, birth defects, and congenital heart disease, among others.

Toxic particles can cross the placenta, the temporary organ that links a baby to the mother through the umbilical cord, and disrupt normal development. They trigger inflammation in the placenta, which creates resistance to blood flow. Over time, the blood vessels become damaged, reducing the amount of blood reaching the fetus.

Air pollution can mess with how nutrients reach the baby, which often leads to low birth weight. Research also shows that when a pregnant woman is exposed to polluted air, the risk of stillbirth goes up, especially in the third trimester.

High levels of fine particulate matter (PM2.5) are linked to low birth weight and premature birth, both of which can cause other health problems. Tiny sooty particles can move through the mother’s bloodstream to the placenta and affect the baby’s lung development, raising the risk of lifelong breathing issues like asthma.

Pollutants such as nitrogen dioxide and PAHs, which come from things like burning food, coal, oil, or gas, can disrupt how organs form. This can increase the chances of conditions like congenital heart defects, neural tube problems, or cleft palate. Some studies also suggest that heavy exposure to air pollution during pregnancy may raise the risk of autism spectrum disorder.

Air pollution can also push the mother’s blood pressure up, increasing the risk of preeclampsia, which is dangerous for both mom and baby.

Early detection of autism in the first 1,000 days of life—covering pregnancy and the first three years—is crucial as the brain develops rapidly in this crucial window, according to Dr Shefali Gulati, Professor, Department of Pediatric Neurology at AIIMS.

During a recent media interaction, Dr Gulati noted that autism spectrum disorder (ASD) is increasingly identified in children worldwide. She stressed that early detection and timely intervention can significantly improve developmental outcomes.

“Early detection is crucial because the brain develops rapidly in the first 1000 days, including pregnancy and the first three years of life. Maximum neuronal connections are formed during this period. If autism is diagnosed early, intervention is more effective. Global data support that early intervention leads to better outcomes,” the pediatric neurologist said.

What Is Autism?

Autism spectrum disorder is a neurodevelopmental disorder in which social interaction and communication are affected, and it can be seen in the early developmental period.

Dr Gulati said that the disorder can now “be identified even in the first year of life. Tools have been developed for children aged 1 to 18 months. At 12 months, sensitivity is about 90 per cent, and at 18 months, it is about 98.7 per cent,” Dr Gulati said.

Further, the expert explained that autism is a spectrum disorder, which means that not everyone has all the symptoms.

Every symptom or sign will not be present in every individual, she said, adding that the severity also differs from person to person. So, two children can be completely different. The symptoms seen in autism, such as difficulties in social interaction, can also be present in neurotypical individuals.

“Earlier, terms like 'normal' and ‘abnormal' were used, which were later replaced with ‘neurotypical’ and ‘special needs’. Now, the concept is neurodiversity. Just like our five fingers are different, individuals also fall along a spectrum. This means we accept that variation as part of normalcy,” the neurologist said.

Autism: What Are The Red flags

The expert clarified that autism is diagnosed clinically through developmental history and behavioral observation, and does not require complex laboratory tests.

Parents, she said, play a key role in identifying early developmental delays. Red flags include:

• lack of response to name,
• absence of meaningful words by 15–16 months,
• failure to form two-word phrases by 24 months

The expert noted that children with autism may prefer to play alone rather than with others. It also “involves restricted, repetitive patterns of behavior and interests, such as moving hands repeatedly, flapping hands, or toe walking”.

“What happens is that these children may be preoccupied or super-focused on a particular part of a toy,” she said.

Dr Gulati pointed to a combination of genetic, epigenetic, and environmental factors associated with autism, including air pollution, pesticide exposure, parental age, and early screen exposure.

Autism: Why Prevalence Is Rising

Highlighting global data, Dr Gulati said autism prevalence has risen sharply, with CDC estimates suggesting about 1 in 31 children affected in recent reports, while WHO estimates indicate about 1 in 100 globally.

She noted that while improved screening and awareness contribute significantly to rising diagnoses, there is also evidence of a genuine increase in cases. Autism prevalence is higher in boys, though rates in girls are increasing.

The neurologist cautioned that autism is a multifactorial condition with no single identifiable cause. Causes include genetic, epigenetic, and environmental factors.

• Genetic factors show high concordance in identical twins (60–90 per cent). Recurrence risk varies depending on family history.
• Environmental factors are significant, including air pollution, pesticide exposure, and parental age. Advanced paternal and maternal age may affect genetic expression.
• Epigenetics—how genes are expressed based on environment—may play a key role.
• Screen time is another factor. Studies show that higher and earlier screen exposure is associated with increased autism risk.

“The goal is not the label, but helping the child reach their full potential through timely and appropriate care,” she said.

With advancements, early detection tools are improving, including video-based assessments and AI-supported tools.

Prevention strategies include primary, secondary, tertiary, and primordial levels. Currently, there is no clear primary prevention, so early diagnosis (secondary prevention) is key, the expert said.