Neurodevelopmental Trajectories of Preterm Born Survivors of Twin–Twin Transfusion Syndrome: From Birth to 5 Years of Age

Knijnenburg, Patricia J.C.; Spruijt, Marjolijn S.; Jansen, Lisette; Rijken, Monique; Tan, Ratna N G B; Slaghekke, Femke; Middeldorp, Johanna M.; Lopriore, Enrico; Klink, Jeanine M.M. van

doi:10.1016/j.jpeds.2021.09.002

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…The prevalence closest to our estimate of 31% was reported in a study by Tosello et althat used scores derived from the Ages and Stages Questionnaire and clinical examination to arrive at a prevalence of 31.4% for children at a mean age of 37 months [23]. The proportion of children with neurodevelopmental impairment in our study was also similar to that reported from a recent study undertaken in The Netherlands, where the rate of impairment was 46% at 5 years, and impairment severity was predominantly mild-moderate [34]. The Dutch estimate arose from routine follow-up of the subgroup of child survivors born before 30 weeks' gestation or small for gestational age, so may not be generalisable to all survivors.…”

Section: Discussionsupporting

confidence: 87%

“…Knijnenburg et al, authors of the 2020 systematic review cited above, recognised that an important limitation of comparison between studies was the substantial difference in length of follow-up, ranging from 1 month to 10 years in the reviewed studies [24]. The review identified probable under-ascertainment of neurodevelopmental impairment in children under the age of five years, a finding supported in their subsequent local study [34]. Similarly, we found the rate of neurodevelopmental impairments in children under 5 was half that of those aged 5 and older.…”

Section: Discussionmentioning

confidence: 99%

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Developmental outcomes for survivors of placental laser photocoagulation for the management of twin-to-twin transfusion syndrome

Guzys,

Reid,

Bolch

et al. 2023

BMC Pregnancy Childbirth

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Background Fetoscopic laser coagulation of placental anastomoses reverses the pathological process in twin-to-twin transfusion syndrome, thereby increasing survival, but there are a paucity of studies addressing long-term neurodevelopmental outcome of survivors. This study aimed to ascertain the presence of neurodevelopmental disabilities in child survivors of monochorionic pregnancies managed by placental laser photocoagulation in the Australian state of Victoria. Methods All pregnancies undergoing placental laser photocoagulation with the Victorian Fetal Therapy Service between 2006–2017 were included. Information on each surviving child, including demographics, perinatal course, and developmental progress was collected from parents, and consent was sought to complete the Child Behaviour Checklist. Interviewers evaluated whether this information was consistent with a diagnosis of any of 14 neurodevelopmental conditions. A three-tiered outcome measure was allocated for each child: (1) unimpaired or developmentally normal, (2) mild or moderate neurological impairment, or (3) severe neurological impairment. Clinical predictors for adverse outcome were identified. Results Of 116 pregnancies (113 twin, 3 triplet), 96 (83%) resulted in 1 + surviving fetuses. 57/113 (50%) twin pregnancies resulted in 2 survivors, 36 (32%) in 1 survivor, and 20 (18%) in no survivors. Of the 235 fetuses, 154 (65.5%) survived to follow-up. Survival increased from 59% in 2006–2008 to 73% in 2015–2017. 90/154 (58%) survivors were followed up at a mean age of 7.5 [SD 3.0] years. Based on parental interview and Child Behaviour Checklist data, 28/90 (31%) participants were assessed as having neurodevelopmental impairment, 27 of mild-moderate severity and 1 severe. Speech/language disorders, attention deficit (hyperactivity) disorders, and fine motor impairment were most common. Neonatal length of stay conferred the highest risk of impairment. Conclusion Substantial variation exists between fetal therapy services in the type and length of neonatal follow-up following fetoscopic laser coagulation, contributing to a lack of data on long-term outcomes. The findings from this study support increasingly urgent calls to undertake systematic and sustained follow-up of fetoscopic laser coagulation survivors until school age. Information from this study may assist parents in their decision-making when offered fetal surgery. Importantly, it highlights a group for targeted surveillance and early intervention.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Developmental outcomes for survivors of placental laser photocoagulation for the management of twin-to-twin transfusion syndrome

Guzys,

Reid,

Bolch

et al. 2023

BMC Pregnancy Childbirth

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“…Furthermore, infants were assessed at a median age of 2, whereas more developmental problems become apparent only at an older age. Therefore, follow-up at least until school age is recommended [21, 22]. The low sample size precludes any analyses on the outcomes of sFGR or TTTS in MCMA twins, which is best assessed in systematic reviews and meta-analyses [23, 24].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Monoamniotic Twin Pregnancies from the First Trimester Onward

et al. 2022

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Introduction: Monochorionic monoamniotic (MCMA) twins are rare, and information is lacking on pregnancy outcomes from the first trimester onward. This study compares the pregnancy and neonatal outcomes between MCMA and monochorionic diamniotic (MCDA) twin pregnancies from the first trimester onward. We also report on the outcomes of MCMA twin pregnancies continuing after 28 weeks and on the neurodevelopmental outcomes of MCMA twins. Methods: A retrospective single-center cohort study of MCMA and MCDA twin pregnancies followed from the first trimester with a fortnightly ultrasound scan. We excluded pregnancies with a major anomaly diagnosed on the first-trimester ultrasound scan. MCMA twin pregnancies were offered inpatient monitoring from 28 weeks onward, and an elective cesarean section was advised between 32 and 33 weeks. MCDA pregnancies were managed as inpatients only if medically indicated, and an elective birth between 36 and 37 weeks was recommended. Results: We analyzed the outcomes of 52 MCMA and 671 MCDA twin pregnancies. In MCMA twins, the fetal and neonatal survival rate was 81/104 (78%) versus 1,192/1,342 (89%) in MCDA twins (p = 0.016). Double intrauterine demise (IUD) was more common in MA than in DA pairs (13% vs. 3%) (p = 0.002). No IUD occurred in the 40 MCMA pregnancies that continued after 28 weeks, but five women (13%) required an urgent cesarean section for fetal distress. Thirty-eight of 52 eligible infants (73%) underwent a neurodevelopmental assessment. Thirty-three (87%) had cognitive and motor development scores within normal limits. Four infants had mild cognitive or motor impairment, and one infant was diagnosed with spastic diplegia. Conclusion: MCMA twins are associated with decreased survival rates compared to MCDA due to increased rates of double IUD. After 28 weeks, about one in eight women required an urgent delivery for fetal distress. Most infants had normal neurodevelopmental outcomes.

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“…In a previous cohort of infants being 2 years’ CA, 62% of the extremely preterm survivors did not have any impairment at 2 years’ CA 8–10. However, several studies showed that the correlation between impairment classification at 2 years of age and at middle childhood is moderate 6 11–13. At later age, the degree of disability may be more clearly defined and may be more likely to be predictive of problems that will continue into later life 6.…”

Section: Introductionmentioning

confidence: 88%

Neurodevelopmental outcome at 5.5 years in Dutch preterm infants born at 24–26 weeks’ gestational age: the EPI-DAF study

van Beek,

Rijken,

Broeders

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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ObjectiveAfter lowering the Dutch threshold for active treatment from 25 to 24 completed weeks’ gestation, survival to discharge increased by 10% in extremely preterm live born infants. Now that this guideline has been implemented, an accurate description of neurodevelopmental outcome at school age is needed.DesignPopulation-based cohort study.SettingAll neonatal intensive care units in the Netherlands.PatientsAll infants born between 240/7and 266/7weeks’ gestation who were 5.5 years’ corrected age (CA) in 2018–2020 were included.Main outcome measuresMain outcome measure was neurodevelopmental outcome at 5.5 years. Neurodevelopmental outcome was a composite outcome defined as none, mild or moderate-to-severe impairment (further defined as neurodevelopmental impairment (NDI)), using corrected cognitive score (Wechsler Preschool and Primary Scale of Intelligence Scale-III-NL), neurological examination and neurosensory function. Additionally, motor score (Movement Assessment Battery for Children-2-NL) was assessed. All assessments were done as part of the nationwide, standardised follow-up programme.ResultsIn the 3-year period, a total of 632 infants survived to 5.5 years’ CA. Data were available for 484 infants (77%). At 5.5 years’ CA, most cognitive and motor (sub)scales were significantly lower compared with the normative mean. Overall, 46% had no impairment, 36% had mild impairment and 18% had NDI. NDI-free survival was 30%, 49% and 67% in live born children at 24, 25 and 26 weeks’ gestation, respectively (p<0.001).ConclusionsAfter lowering the threshold for supporting active treatment from 25 to 24 completed weeks’ gestation, a considerable proportion of the surviving extremely preterm children did not have any impairment at 5.5 years’ CA.

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Neurodevelopmental Trajectories of Preterm Born Survivors of Twin–Twin Transfusion Syndrome: From Birth to 5 Years of Age

Cited by 6 publications

References 26 publications

Developmental outcomes for survivors of placental laser photocoagulation for the management of twin-to-twin transfusion syndrome

Developmental outcomes for survivors of placental laser photocoagulation for the management of twin-to-twin transfusion syndrome

Outcomes of Monoamniotic Twin Pregnancies from the First Trimester Onward

Neurodevelopmental outcome at 5.5 years in Dutch preterm infants born at 24–26 weeks’ gestational age: the EPI-DAF study

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