Prevalence and risk factors of cerebral lesions in neonates after laser surgery for twin-twin transfusion syndrome

Abstract

Objective To identify risk factors for cerebral lesions among survivors of TTTS treated with laser surgery. Study Design A multilevel regression analysis examined risk factors for neonatal cerebral lesions identified by imaging. Imaging was routine in “high-risk survivors”, defined as those delivered at <32 weeks' gestation, and by clinical indications if born later. Severe lesions were defined as: intraventricular hemorrhage grade III–IV, cystic periventricular leukomalacia, ventriculomegaly and/or hydrocephalus, microcephaly, infarctions, porencephalic/Dandy-Walker cysts, or bilateral other cysts. Results For 262 consecutive laser-treated TTTS patients, 18 neonates had severe lesions identified among 427 individual survivors (4.2%) and 242 “high-risk survivors” (7.4%). Forty-six newborns had any cerebral lesion, resulting in lesion rates of 10.8%–19.0%. Delivery <32 weeks' (OR=4.95, p<0.001) and <28 weeks' (OR=6.25, p<0.001) gestation were associated with increased likelihood of any cerebral lesion. Conclusions This cohort showed low rates (4–7%) of severe neonatal cerebral lesions, with prematurity being the primary risk factor.

Outcome reporting across randomized trials and observational studies evaluating treatments for twin–twin transfusion syndrome: systematic review

“…Two hundred and thirty studies were therefore deemed eligible after full‐text review. From these, all randomized trials ( n = 6) and the largest observational studies ( n = 94) were selected for analysis (Figure ). There were 13 case–control studies, 32 prospective cohort studies and 49 retrospective cohort studies.…”

Endoscopic Placental Laser Coagulation in Monochorionic Diamniotic Twins with Type II Selective Fetal Growth Restriction

“…This is mainly because the patients were referred for surgery from other centres, often from other countries, where the subsequent management of the pregnancy and the neonates was undertaken. Nevertheless, comparisons can be made with other studies on the basis of the gestational age at delivery of the survivors after laser surgery, which is the main determinant of prevalence of neonatal cerebral lesions [19] and long-term neurological outcome [20]. Douglas et al [19] performed neonatal imaging in survivors after endoscopic laser surgery and reported severe cerebral lesions in 18.4, 7.3 and 3.7% of those born at 24-27, 28-31 and ≥32 weeks' gestation, respectively.…”

Selective Reduction Using Intravascular Potassium Chloride Injection after Laser Surgery for Twin-Twin Transfusion Syndrome

“…There is no doubt that the type and extent of cerebral lesion can impact neurological prognosis. Studies have reported that, after TTTS laser surgery, ultrasound and/or MRI obtained at various gestational ages or shortly after birth reveal a cerebral lesion in approximately 4-7% of fetuses [4]. According to a systematic review and meta-analysis, the baseline risk of neurodevelopmental impairment after laser therapy for TTTS is approximately 11% [5].…”