Behavioural outcome in twin–twin transfusion syndrome survivors treated with laser surgery

Abstract

ObjectiveEvaluate the incidence of and risk factors for behavioural problems in twin–twin transfusion syndrome (TTTS) survivors treated with fetoscopic laser coagulation.DesignObservational cohort study.SettingNational referral center for fetal therapy, Leiden University Medical Center, The Netherlands.PatientsBehavioural outcome was assessed in 417 TTTS survivors, at the age of 2 years.InterventionsParents completed the Child Behavior Checklist for their twins. Antenatal, neonatal and follow-up data including Bayley III and a neurological exam were recorded from the medical database.Main outcome measuresThe incidence of and risk factors for behavioural problems.Results332 twin pregnancies (664 fetuses) were treated with fetoscopic laser for TTTS between 2008 and 2015. For 517 children eligible for follow-up, 417 (81%) Child Behavior Checklist questionnaires were completed. The study group was born at a mean gestational age of 32.8 weeks±3.2. Total behavioural problems within the borderline to clinical range were reported in 8% (95% CI 5.9 to 11.2) of survivors, compared with 10% in the general Dutch population (p=0.12). No difference between donors and recipients was detected (p=0.84). Internalising and externalising problems were reported in 9.4% (95% CI 6.9 to 12.6) and 11.5% (95% CI 8.8 to 15.0), respectively. Severe neurodevelopmental impairment was more frequent in the children with behavioural problems. High maternal educational level was associated with lower behavioural problem scores.ConclusionParents of twins treated with fetoscopic laser therapy for TTTS do not report more behavioural problems compared with general population norms. More behavioural problems are reported in children with severe neurodevelopmental impairment.

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

“…A previous study by our center reported a similar rate of behavioral problems in survivors of TTTS as in the normal population. 27 The rate of behavioral problems in this study is consistent with these results. At a younger age, impairment can potentially remain concealed due to low test sensitivity (ie, Bayley scales vs Wechsler scales).…”

Infantile neurodevelopmental outcome after fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome: the first prospective experience from Iran

“…In a survey of 78 pregnant mothers who had undergone laser treatment 18% of the cases developed neurologic impairment [ 11 ]. In a similar study on 332 twins, no difference was noted between the incidence of neurologic impairment in the normal population and twins with TTTS [ 12 ]. Otherwise, NDI was not different according to the TTTS stages.…”

A Systematic Review of Elective Laser Therapy during Pregnancy

“…[49][50][51][52][53] A study showed that endoscopic laser therapy had better outcomes in overall survival, neurologic morbidity, and Laser Therapy During Pregnancy neonatal death compared with serial amnioreduction. [54][55][56][57] Behavioral problems did not increase in twins treated with laser ablation compared with the general population. 58 After fetoscopic laser surgery, complications such as placental abruption, preterm premature rupture of the membranes, persistent trophoblastic disease, and intrauterine fetal death may increase.…”