Risk Factors for Neurodevelopment Impairment in Twin–Twin Transfusion Syndrome Treated With Fetoscopic Laser Surgery

Abstract

II.

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

“…Overall, the incidence of NDI was 18% (50/278). Four risk factors were found to be significantly associated with increased risk for NDI: gestational age at laser surgery (odds ratio [OR] 1.30, 95% CI: 1.0-1.7; p = .05), Quintero stage (OR 3.55 for each increment in stage, 95% CI: 1.1-11.8; p = .04), lower gestational age at birth (OR 1.39 for each week, 95% CI 1.1-1.8; p = .01), and lower birth weight (OR 1.18 for each 100-g decrease, 95% CI 1.1-1.3; p = < .01; Lopriore et al, 2009). Gray et al (2011) found a 4% (5/113) incidence of CP and NDI was diagnosed in 12% (14/113) of TTTS survivors.…”

“…Low gestational age at birth was significantly associated with NDI (relative risk [RR]: 1.20 for each week, 95% CI: 1.1-1.4; p = .02). In 2009, three European fetal therapy centers (Barcelona, Leuven, and Leiden) performed a multicenter follow-up study to investigate risk factors for NDI in TTTS treated with laser (Lopriore et al, 2009). Overall, the incidence of NDI was 18% (50/278).…”

“…Although standardized neurological assessment and developmental tests were employed, the timing of follow-up was too early for a reliable diagnosis of CP or developmental delay. McIntosh et al (2014) investigated the long-term neurodevelopmental outcome of a cohort of 3-to 5-year-old Note: Two follow-up studies (Lopriore et al, 2007;van Klink et al, 2014) in TTTS after laser are not included in this table because the included children are more fully described in the multi-center follow-up of this studies (Lopriore et al, 2009;van Klink et al, 2015b). CP = cerebral palsy; NDI = neuro developmental impairment defined as CP, severe cognitive and/or motor delay (<2 SD), blindness and/ or deafness; NND = neonatal death; GP = general practitioner; GA = gestational age.…”

Twin‐twin transfusion syndrome: the good news is; there is still room for improvement …

“…In our series, the neonatal death rate is about 8%. In other words, our live-birth rate is 8% higher than our neonatal survival rate (8). Not only is there no information on neonatal mortality in that series, also information on neonatal morbidity, a strong predictor of long-term outcome, is lacking.…”

“…Of surviving infants, 11% have some form of developmental impairment, of which cerebral palsy is the most common, being present in 5% (7). The single most important predictor of impairment is an early gestational age at birth (8). Therefore, at best only 40% of parents will ultimately take home two healthy babies.…”