Long-term neurodevelopmental outcome of 167 children after intrauterine laser treatment for severe twin-twin transfusion syndrome

Graef, Cornelia; Ellenrieder, B.; Hecher, Kurt; Hackelöer, Bernhard-Joachim; Huber, Agnes; Bartmann, Peter

doi:10.1016/j.ajog.2005.07.040

Cited by 151 publications

(61 citation statements)

References 19 publications

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“…Our results are in keeping with other studies that found neurological impairment (minor or severe) ranging from 4.6% to 17% after FLC procedure 6,7,11,12,13,16,17 . Another interesting finding was that neurodevelopmental impairment occurred in 10% of monochorionic diamniotic twin pregnancies without TTTS 18 .…”

Section: Discussionsupporting

confidence: 82%

“…It seems that low GA at birth is the major risk factor for adverse neurodevelopmental outcome. There is no increased risk between donors and recipients, either when the two siblings survived or when only one child survived 1,2,3,11,12,19,20,21,22 . Although our data showed significant prematurity (89.6%) and advanced stages of Quintero (89.6% in stage II, III, IV) as major points of concern, our children reached the expected responses and were classified mostly within the normal range of development.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with other treatment options like serial amniocenteses, the FLC seems to achieve both higher survival rates and a lower rate of long-term morbidity, such as neurologic or developmental abnormality. Besides, it is well established that the amnioreduction is associated with an increased risk of severe cerebral injury compared to laser surgery in survivors of TTTS 4,11,12 . Therefore, laser treatment seems to be the treatment of choice, since the incidence of cerebral palsy in the group of survivors treated with Table 2.…”

Section: Discussionmentioning

confidence: 99%

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Twin-twin transfusion syndrome: neurodevelopmental screening test

Arias

Campos

Campos-Zanelli

et al. 2015

Arq. Neuro-Psiquiatr.

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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...

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Twin-twin transfusion syndrome: neurodevelopmental screening test

Arias

Campos

Campos-Zanelli

et al. 2015

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

show abstract

“…These shifted growth curves are more likely to reflect abnormal development at the microscopic level rather than simply delayed development, given the abnormal neurodevelopmental outcomes in TTTS. 4,5,9,11 It is not unusual for subtle diffuse structural abnormalities to manifest as neurodevelopmental pathology, such as learning disabilities, attention deficit disorder, and behavioral disorders (autism), in contrast to the apparent neurologic deficits associated mainly with readily recognizable focal lesions (porencephaly, cystic PVL), such as in cerebral palsy. As can be seen in premature birth survivors, these diffuse changes may be rather common and may have significant impact on long-term outcomes for surviving children with TTTS.…”

Section: Hypoplastic Cerebrum and Cerebellum: Neuropathophysiology Ofmentioning

confidence: 99%

“…In twins, TTTS is a significant cause of cerebral palsy (motor disability) and cognitive and behavioral disabilities 4,5 and is a major cause of prematurity. [6][7][8] There is a high risk of morbidity (12%-22%) 4,[9][10][11] and perinatal mortality (30%) in survivors even after treatment.…”

mentioning

confidence: 99%