Neurodevelopmental outcome at 6 years of age after intrauterine laser therapy for twin‐twin transfusion syndrome

Abstract

This study was undertaken to evaluate neurodevelopmental outcome of children at 6 years of age after intrauterine laser therapy for Twin-twin transfusion syndrome (TTTS). This is part of a longitudinal study in children after intrauterine laser therapy for TTTS; 190 of 254 (74.8%) children, previously investigated at a median age of 2 years 10 months, were re-evaluated at 6 years 5 months (range 4 years 11 months -10 years 4 months). Sixty-four patients were not examined due to loss of contact. The median gestational age at birth was 34 + 3 weeks. The study included a physical/neurological examination, a standardized neurodevelopmental test (Kaufman-ABC) and/or results from the national screening programme for children as well as questionnaires. Patients were grouped in three outcome categories: group I: normal examination and test result; group II: minor neurological deficiencies and normal test results; group III: major neurological deficiencies and/or test results below minus two standard deviations. The following results were obtained at 6 years 5 months (for comparison, results of the same patients at 2 years 10 months in brackets). Group I: 79.5% (84.2%); group II: 11.6% (8.9%); group III: 8.9% (6.8%). Twenty-one (11%) patients had a worse and 8 (4.2%) an improved classification at 6 years 5 months as compared to 2 years 10 months. Overall, the results with 6 years did not significantly differ from the results with 2 years. Neurodevelopmental outcome at 6 years 5 months was not statistically, significantly different from outcome at 2 years 10 months.

Long-Term Neurodevelopmental Outcome in Survivors of Twin-to-Twin Transfusion Syndrome

“…Hence, children with severe cognitive delay but without CP were not included in the group with NDI. Neurodevelopmental outcome of 190 of these 256 children was re-evaluated at a median age of 6 years and 5 months (Graeve et al, 2012). NDI, now defined as major neurologic deficiencies (CP) and severe cognitive delay as measured with a standardized intelligence test, was detected in 9% (17/190).…”

Twin-twin transfusion syndrome: neurodevelopmental screening test

“…It seems that low GA at birth is the major risk factor for adverse neurodevelopmental outcome. There is no increased risk between donors and recipients, either when the two siblings survived or when only one child survived 1,2,3,11,12,19,20,21,22 . Although our data showed significant prematurity (89.6%) and advanced stages of Quintero (89.6% in stage II, III, IV) as major points of concern, our children reached the expected responses and were classified mostly within the normal range of development.…”

“…Conclusão: A maioria das crianças alcançou o desenvolvimento esperado de acordo para idade. Apesar do bom desenvolvimento neurológico, crianças classificadas na categoria de risco devem ser monitoradas para o desenvolvimento, durante a infância.Palavras-chave: criança, desenvolvimento infantil, doenças em gêmeos, transfusão feto-fetal.Twin-twin transfusion syndrome (TTTS) occurs in approximately 10%-15% of all monochorionic diamniotic twin pregnancies, develops typically between 15 and 26 weeks of gestation and is associated with a high perinatal morbidity and mortality 1,2,3 . The pathophysiology of TTTS is an unbalanced transfusion of blood across placental vascular anastomoses from one twin (donor) to the other (recipient).…”

“…Twin-twin transfusion syndrome (TTTS) occurs in approximately 10%-15% of all monochorionic diamniotic twin pregnancies, develops typically between 15 and 26 weeks of gestation and is associated with a high perinatal morbidity and mortality 1,2,3 . The pathophysiology of TTTS is an unbalanced transfusion of blood across placental vascular anastomoses from one twin (donor) to the other (recipient).…”

“…Due to uncertainty about the long-term neurological and cognitive development after laser treatment for TTTS, some authors suggest that children should be examined at two years, and that the next appropriate time point is the beginning of school age around six years 3 . With higher survival rates, an increasing number of follow-up studies in TTTS survivors are being published, shedding more light on long-term neurodevelopmental outcome 2 .…”