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The 5-year-old twins found vomiting and foaming at the mouth in a Bronx apartment were smothered to death.

An autopsy determined that George and Gianna Katanka were asphyxiated, the medical examiner told the NY Post on Wednesday.

Police originally believed the twins died in a “medical emergency” in December 2023.

The children were found on the living room floor of their apartment on East 175th Street near Weeks Avenue in Mount Hope on Dec. 18, 2023.

The mother, who has not been named, told police her special needs children were sick and vomiting for hours.

The boy had been sick for two weeks with cold symptoms. The school sent him home that Monday. His sister was diagnosed with an ear infection, and had been biting and spitting at school, the mother told police.

The mother said she took a quick shower, and came out around 11 a.m. She found the children foaming at the mouth and nose in bed.

The mother called 911, NYPD Chief of Detectives Joseph Kenny told reporters. The children were pronounced dead.

Neither child had signs of physical abuse. No drugs were found in the apartment.

The twins’ father was at work at the time of the incident, according to the NYPD.

“All reports were that mom was well engaged with everything to do with these two children,” Kenny said at a press briefing on Tuesday.

“She was an active participant with their medical care, an active participant in their schooling,” he said. “Neighbors say she was doting, and they were a quiet, loving family.”

No one is in custody, The Post reported Thursday.