Natalia and Sofia Fortunato weighed about 1 and 2 pounds when they were born at 28 weeks and 2 days into their mother's pregnancy, the smallest possible start after doctors discovered the identical twins were locked in a life-threatening battle over a shared placenta. Two years later, the sisters are walking, dancing and talking, a milestone their mother calls nothing short of a blessing.
The twins were diagnosed before birth with twin-to-twin transfusion syndrome, a rare and potentially fatal complication of monochorionic pregnancy in which uneven blood flow through a shared placenta causes one twin to receive too much blood and the other too little, according to the Las Vegas Sun. In the Fortunato twins' case, the so-called recipient twin developed excess fluid and a strained heart, while the donor twin was left with dangerously little amniotic fluid. Jenna Fortunato said one of her daughters was headed toward heart failure while the other had barely any fluid at all.
Twin-to-twin transfusion syndrome affects 10% to 15% of monochorionic twin pregnancies and occurs in just 1 to 3 of every 10,000 births overall, per the Sun's reporting. Left untreated, severe cases carry a fetal or neonatal mortality rate of 60% to 100%, per Medscape data cited in the same report. The syndrome can lead to premature birth and neurological complications, underscoring how narrow the margin was for Natalia and Sofia.
A Race Against a Shared Placenta
Monochorionic pregnancies, in which identical twins share a single placenta, carry risks that don't exist in typical twin gestations. According to the Society for Maternal-Fetal Medicine, these pregnancies make up roughly 20% of twin gestations and carry a five-fold higher risk of fetal death compared to singleton pregnancies, precisely because of the shared vascular connections that can trigger disorders like TTTS. Left unmanaged in its most severe, early-onset form, the syndrome carries an 80% to 100% mortality rate, though fetoscopic laser ablation has pushed survival odds for at least one twin up to 90% to 92%, according to Cleveland Clinic's Consult QD.
Fetoscopic laser ablation is a treatment for severe TTTS. When Natalia and Sofia arrived at 28 weeks and 2 days, they were born very preterm and weighing about 1 and 2 pounds, small enough that survival itself, not just recovery, was the immediate goal.
Fifty-Three and Sixty-Five Days in the NICU
Natalia spent 53 days in Sunrise's NICU, while her sister Sofia needed 65 days there. Babies born before 32 weeks can face breathing, feeding, infection and developmental complications, all risks that Sunrise Children's Hospital's Level III unit is built to manage. Under American Academy of Pediatrics standards, Level III NICUs are certified to provide continuous mechanical ventilation and comprehensive critical care for infants born before 32 weeks or weighing under 1,500 grams, about 3.3 pounds, according to guidance from Lurie Children's.
Jenna Fortunato credited the Sunrise Children's Hospital team with helping her daughters survive, and summed up the experience simply: “We're very blessed.” Sunrise operates a 72-bed Level III NICU and is Nevada's only provider of neonatal extracorporeal membrane oxygenation, an artificial heart-lung support system for critically ill newborns, according to Sunrise Children's Hospital. The hospital opened Southern Nevada's first NICU in 1974 and was the first in Nevada to use whole-body cooling therapy, and it now cares for more than 1,000 NICU patients a year, admitting more than 100 babies weighing less than 3 pounds at birth annually.
A Preterm Birth Crisis Across Southern Nevada
The twins' story unfolds against a backdrop of elevated premature birth rates across the region. Nevada recorded an 11.0% preterm birth rate in 2024, earning the state a “D” grade and a 37th-place national ranking, according to the March of Dimes.
Nationally, NICU admission rates among premature infants climbed from 49.1% in 2016 to 51.6% in 2023, per CDC National Vital Statistics System data highlighted in Hoodline's earlier report on a 95-day NICU stay. That rising demand highlights the need for intensive, highly specialized care in complex cases like the Fortunato twins' TTTS diagnosis.
Long-term outcomes for TTTS survivors vary. At age 2, Natalia and Sofia were walking, dancing and talking.
Marking the Milestone With a Reunion
Sunrise Children's Hospital will hold its annual NICU reunion on October 10, running from 11 a.m. to 2 p.m. at a medical office building near the hospital. Past reunions have brought together more than 80 former NICU families with the doctors and nurses who cared for their children, a tradition that mirrors similar gatherings at other hospitals, including a recent reunion event covered by Hoodline at a Kansas City NICU. For the Fortunato family, the October gathering will be a chance to reconnect with the team that guided Natalia and Sofia through their earliest, most fragile days.
