Twin-twin transfusion syndrome: neurodevelopmental screening test

Abstract

Objective: To assess the neurodevelopmental functions (cognition, language and motor function) of survivors of twin-twin transfusion syndrome (TTTS). Method: Observational cross-sectional study of a total of 67 monochorionic diamniotic twins who underwent fetoscopic laser coagulation (FLC) for treatment of TTTS. The study was conducted at the Center for Investigation in Pediatrics (CIPED), Universidade Estadual de Campinas. Ages ranged from one month and four days to two years four months. Bayley Scales of Infant and Toddler Development Screening Test-III, were used for evaluation. Results: Most children reached the competent category and were classified as having appropriate performance. The preterm children scored worse than term infants for gross motor subtest (p = 0.036). Conclusion: The majority of children reached the expected development according to their age. Despite the good neurodevelopment, children classified at risk should be monitored for development throughout childhood.Keywords: child, child development, diseases in twins, fetofetal transfusion. RESUMOObjetivo: Avaliar as funções do desenvolvimento neurológico (cognição, linguagem e motricidade) de sobreviventes da síndrome de transfusão feto-fetal (STFF). Método: Estudo transversal observacional, total de 67 gêmeos diamnióticos monocoriônicos submetidos à coagulação a laser por fetoscopia para o tratamento da STFF. O estudo foi realizado no Centro de Investigação em Pediatria (CIPED), Universidade Estadual de Campinas. A idade variou entre um mês e quatro dias a dois anos e quatro meses. Foram utilizadas as Bayley Scales of Infant and Toddler Development Screening Test-III para avaliação. Resultados: A maioria das crianças atingiu a categoria competente e foi classificada como tendo desempenho adequado. As crianças prematuras obtiveram desempenho inferior quando comparadas às nascidas a termo no subteste motor global (p = 0,036). 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 results in a volume-depleted donor twin with signs of oliguria and oligo/anhydramnios and a volumeoverloaded recipient twin with polyuria and polyhydramnios, which may lead to impairment of various organ systems in both affected twins 4 . Serial amnioreduction and fetoscopic laser coagulation (FLC) of placental anastomoses are the two main treatment options...

New trends in instruments for child development screening in Brazil: a systematic review

“…In general, the studies used tests for screening child development to assess children in the age group corresponding to the tests' target population, thus reaffirming the appropriateness of using them for the population age profile they evaluate. In addition, the analysis of the studies' objectives underscored the fact that (34).…”

“…It is important to highlight that six studies included only children under two years of age [11][12][13][14][15][16] . For the most part, the target populations were children with normal development 11,12,15,[17][18][19][20][21][22][23][24][25][26][27][28] or children at-risk for delays 14,16,[29][30][31][32][33][34][35][36] . Two studies included children with confirmed disability diagnoses, such as cerebral palsy 37 and microcephaly 13 .…”

Twin-To-Twin Transfusion Syndrome Donor and Recipient and Their Subsequent Cognitive Functioning in Late Childhood as Juvenile Athletes—A Case Study

“…Intelligence levels depend on, inter alia, gestational age, Quintero stage of TTTS severity, and head circumference [ 2 , 16 ]. Few reports indicate that twins after TTTS do not show significant differences on intellectual functioning tests in childhood [ 16 , 17 , 18 ], but some researchers have also found difficulties with executive functioning and neuro-optometric deficiencies, which interfere with neurocognitive functioning [ 14 ]. Apart from early developmental support for premature children (and those affected by TTTS), clinical observations also emphasize the potential rehabilitation benefits of physical activity (e.g., playing football) in this group of children.…”

Uso da Escala de Avaliação do Desenvolvimento Infantil Bayley III em Crianças Brasileiras: Revisão Sistemática

“…Para tal mensuração, com base nos estudos já realizados, nota-se a utilização de testes ou escalas de desenvolvimento infantil, as quais se orientam para sua aplicação por marcos ou indicadores de desenvolvimento, que são as habilidades e ações que parte considerável das crianças devem realizar em determinada faixa etária (Alcantud, Esteban & Bañón, 2015). Dentre as escalas que avaliam o desenvolvimento infantil, cita-se a Escala Bayley III (2006), considerada padrão ouro e utilizada em diversas populações infantis, sendo inclusive necessário reunir evidências de validade do instrumento para uso no Brasil (Anderson, De Luca, Hutchinson, Roberts & Doyle, 2010;Arias et al, 2015;Baltieri et al, 2010;Neves et al, 2016;Santos et al, 2013).…”