Long‐term neurodevelopmental outcome after selective feticide in monochorionic pregnancies

Klink, Jmm van; Koopman, Hendrik M.; Middeldorp, J.M.; Klumper, F. J. C. M.; Rijken, Monique; Oepkes, Dick; Lopriore, Enrico

doi:10.1111/1471-0528.13490

Cited by 29 publications

(38 citation statements)

References 33 publications

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“…Our results suggest that long-term NDI in this specific high-risk cohort occurs in 15% of survivors, which is above the range of the incidence of NDI reported in case series treated with other fetal therapies (5-10%) [21][22][23][24]. The rate of NDI in children treated with intrauterine transfusion for alloimmune hemolytic disease was reported in 5% [21].…”

Section: Discussionmentioning

confidence: 43%

“…In children treated with fetoscopic laser surgery for twin-twin transfusion syndrome, long-term NDI occurs in 10% in most recent series [25]. NDI has been reported in 7% of children treated with selective reduction in complicated monochorionic twin pregnancies [22]. In most studies, prematurity and severe neonatal morbidity were identified as potential risk factors for NDI.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Neurodevelopmental and Respiratory Outcome after Intrauterine Therapy for Fetal Thoracic Abnormalities

et al. 2018

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Introduction: The aim of this study is to evaluate long-term neurodevelopmental and respiratory outcome after fetal therapy for fetal pleural effusion, congenital cystic adenomatoid malformation, and bronchopulmonary sequestration. Methods: Children ≥18 months of age underwent an assessment of neurologic, motor, and cognitive development. Medical records were reviewed to determine respiratory outcome. Behavioral outcome was assessed using the Child Behavioral Checklist. Results: Between 2001 and 2016, 63 fetuses with fetal hydrops secondary to thoracic abnormalities were treated at our center. Overall perinatal survival was 64% (40/63). Twenty-six children were included for follow-up (median age 55 months). Severe neurodevelopmental impairment (NDI) was detected in 15% (4/26). Three out of 4 children with severe NDI had associated causes contributing to the impairment. Overall adverse outcome, including perinatal mortality or NDI, was 55% (27/49). Fifteen percent (4/26) had severe respiratory sequelae. Parents did not report more behavioral problems than Dutch norms. Discussion: Our results suggest that severe NDI in this specific high-risk cohort occurs in 15%, which is above the range of the incidence of NDI reported in case series treated with other fetal therapies (5–10%). Large multicenter studies and an international web-based registry are warranted to prospectively gather outcome data at fixed time points.

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Section: Discussionmentioning

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Long-Term Neurodevelopmental and Respiratory Outcome after Intrauterine Therapy for Fetal Thoracic Abnormalities

et al. 2018

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“…As an alternative to UCC, FLP can be considered a powerful option for sIUGR twins accompanied by oligohydramnios to help ensure the survival of both twins. According to a previous study investigating long-term outcomes after selective feticide for 74 cases of complicated monochorionic twin gestations including eight cases of sIUGR, the incidence of neurodevelopmental impairment of survivors of at least 2 years of age was 6.8% [25]. However, because of the lack of large studies on the neurodevelopment of surviving twins with sIUGR after prenatal interventions, the comparative merits and demerits of UCC and FLP, especially for larger twins, are unknown.…”

Section: Discussionmentioning

confidence: 99%

Survival Rate without Brain Abnormalities on Postnatal Ultrasonography among Monochorionic Twins after Fetoscopic Laser Photocoagulation for Selective Intrauterine Growth Restriction with Concomitant Oligohydramnios

Ishii

Wada

Takano³

et al. 2018

Fetal Diagn Ther

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Introduction: We aimed to clarify the survival rate without brain abnormalities (BA) after fetoscopic laser photocoagulation (FLP) for monochorionic diamniotic twin gestations (MCDA) with selective intrauterine growth restriction (sIUGR) accompanied by abnormal umbilical artery (UA) Doppler waveforms and isolated oligohydramnios in the sIUGR twin. Materials and Methods: This retrospective study included 52 cases that underwent FLP. The main outcome was survival rate without BA of the twins at age 28 days. BA was defined as severe intraventricular hemorrhage and periventricular leukomalacia on postnatal ultrasonography. Results: Median gestational age at FLP was 20 (16–24) weeks. Ten cases were classified as type III based on Doppler for the UA. For all cases, including 20 cases of anterior placenta, FLP was completed without major intraoperative complications. Amnioinfusion was required in 49 cases for better fetoscopic visualization. Fetal loss occurred in 29 sIUGR twins and two larger twins, whereas one larger twin experienced neonatal death. Survival rates without BA were 44% (n = 23) for sIUGR twins and 94% (n = 49) for the larger twins. Discussion: FLP for MCDA with sIUGR presenting with oligohydramnios in the sIUGR twin might be considered a prenatal treatment option.

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“…2,5,9,[28][29][30][31][32][33][34] De facto, Pharoah et al 12 atribuem um risco de alterações neurológicas graves a cerca de metade dos sobreviventes de uma gestação com óbito do co-gémeo. Na revisão sistemática de Ong et al 11 é referido um risco de alterações neurológicas em 18,0% dos sobreviventes de gestações com óbito de um gémeo, representando um risco de seis e quatro vezes superior nas gestações monocoriónicas e bicoriónicas, respetivamente.…”

Section: 3unclassified

Neurodesenvolvimento de Grandes Prematuros ou Recém-Nascidos com Muito Baixo Peso: Comparação de Gémeos Monocoriónicos e Bicoriónicos com Recém-Nascidos de Gestação Unifetal

Taborda

Oliveira

2016

Acta Med Port

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Os gémeos monocoriónicos apresentaram maior risco, em relação ao grupo de gestação unifetal, de alterações moderadas a graves do neurodesenvolvimento global (OR ajustado 3,6) e nas subáreas: locomoção (OR ajustado 12,2) linguagem (OR ajustado 6,5) e autonomia (OR ajustado 7,2). A paralisia cerebral foi diagnosticada em 15,4% dos gémeos monocoriónicos e 4,1% de gestação unifetal (OR ajustado 4,2). Discussão: Este trabalho evidenciou taxa superior de alterações moderadas a graves do neurodesenvolvimento, incluindo a paralisia cerebral nos gémeos monocoriónicos em relação ao grupo de gestação unifetal. A análise por grupos estratificados em relação à idade gestacional e a comparação de monocoriónicos com bicoriónicos alertou para o papel da corionicidade na base destas sequelas. Conclusão: Podemos concluir que os gémeos monocoriónicos apresentaram, na população estudada, um risco significativo de sequelas moderadas a graves do neurodesenvolvimento. Palavras-chave: Córion; Deficiências do Desenvolvimento; Gémeos; Paralisia Cerebral; Recém-Nascido Extremamente Prematuro; Recém-Nascido de Muito Baixo Peso. ABSTRACT Introduction:Twins are associated with a delayed development and cerebral palsy. The purpose of this work was to compare the neurologic morbidity in very preterm or very low birth weight dichorionic and monochorionic twins with singletons. Material and Methods:We conducted a retrospective cohort study of livebirths lowest through 32 weeks of gestation or very low weight infants admitted to Neonatal Intensive Care Unit of a level III hospital, between 2006 and 2010. Development was evaluated with the Growing Skills II Scale at 24 months of age. Cerebral palsy was defined by predetermined criteria by Surveillance of Cerebral Palsy in Europe. Infants were analyzed as twins and singletons cohort. Within the twin category the infants were further separated as dichorionic and monochorionic and were compared with singletons infants. Logistic regression models were used to control for demographic and clinical factors. Results:The cohort of infants who were assessed for neurodevelopmental impaired, consisted of 194 singletons infants and 89 twins (50 dichorionic; 39 monochorionic). Monochorionic twins, when compared with the singletons, showed an increased risk of severe developmental delay in these areas: locomotion (adjusted OR 12.2) language (adjusted OR 6.5) and autonomy (adjusted OR 7.2). Cerebral palsy was diagnosed in 4.1% of singleton infants and 15.4% of monochorionic twins. The adjusted risk of severe developmental delay and cerebral palsy in monochorionic twins was 3.6 and 4.2, respectively. Discussion: This work showed higher rate of moderate and severe neurodevelopment delay including cerebral palsy in monochorionic twins compared to singletons infants. Analysis by groups stratified according to gestational age and comparison of monochorionic and dichorionic twins displayed the role of chorionicity for these neurodevelopmental disorders.Conclusions: In our sample the monochorionic twins are associated w...

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Long‐term neurodevelopmental outcome after selective feticide in monochorionic pregnancies

Cited by 29 publications

References 33 publications

Long-Term Neurodevelopmental and Respiratory Outcome after Intrauterine Therapy for Fetal Thoracic Abnormalities

Long-Term Neurodevelopmental and Respiratory Outcome after Intrauterine Therapy for Fetal Thoracic Abnormalities

Survival Rate without Brain Abnormalities on Postnatal Ultrasonography among Monochorionic Twins after Fetoscopic Laser Photocoagulation for Selective Intrauterine Growth Restriction with Concomitant Oligohydramnios

Neurodesenvolvimento de Grandes Prematuros ou Recém-Nascidos com Muito Baixo Peso: Comparação de Gémeos Monocoriónicos e Bicoriónicos com Recém-Nascidos de Gestação Unifetal

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