Neurodevelopmental impairment at 3 years of age after fetoscopic laser surgery for twin‐to‐twin transfusion syndrome

Abstract

BackgroundData on neurodevelopmental outcomes of children surviving after fetoscopic laser surgery (FLS) for twin‐to‐twin transfusion syndrome (TTTS) are scarce.MethodsWe retrospectively investigated children surviving after FLS for TTTS at 16 to 26 weeks' gestation between 2003 and 2014. Children were evaluated by standardized neurologic examinations using the Kyoto Scale 2001 at a corrected age of 3 years ± 6 months. Neurodevelopmental impairment (NDI) was defined as cerebral palsy (CP), bilateral blindness, bilateral deafness or a developmental quotient (DQ) < 70 points. Brain magnetic resonance imaging (MRI) was performed at term‐equivalent age.ResultsA total of 188 children from 110 twin pregnancies were evaluated. NDI was detected in 16/188 (8.5%) children, including six cases of CP (3.2%). No children had bilateral blindness or deafness. An earlier gestational age at delivery was associated with a higher incidence of NDI (P < .001). Abnormal brain MRI findings were detected in 9/16 (56%) of children with NDI, including 6/6 (100%) with CP.ConclusionThe incidence of NDI in children following FLS at 3 years old was 8.5%. Prematurity is a strong risk factor for NDI. Brain MRI may predict the development of CP.

Perinatal risk factors of neurodevelopmental impairment after fetoscopic laser photocoagulation for twin–twin transfusion syndrome: systematic review and meta‐analysis

“…Study or subgroup Lopriore (2009) 11 Tosello (2014) 9 Sananès (2016) 10 Korsakissok (2018) 22 Gijtenbeek (2020) 14 Matsushima (2020) 23 11 Tosello (2014) 9 Sananès (2016) 10 Korsakissok (2018) 22 Gijtenbeek (2020) 14 Gijtenbeek (2020) 14 Matsushima (2020) 23 11 Sananès (2016) 10 Korsakissok (2018) 22 Matsushima (2020) 23 difference, -343.26 g (95% CI, -470.59 to -215.92 g); P < 0.00001, I 2 = 27%). No significant difference was seen in the rate of SGA (P = 0.14) or cotwin demise (P = 0.77) between the NDI and non-NDI cases.…”

“…All included studies were published between 2009 and 2020. Three studies were conducted in France 9,10,22 , two in The Netherlands 11,14 , two in Australia 8,12 , one in Japan 23 and one in Germany 13 . Three studies were prospective 10,12,22 , five studies were retrospective 8,9,11,14,23 and the design of one study was not reported 13 .…”

Risk Profiling of the Solomon Technique versus Selective Technique of Fetoscopic Laser Surgery for Twin–Twin Transfusion Syndrome

“…Third, we only reported the short-term outcomes with some procedural parameters. The long-term outcomes and the results of neurological examinations are very important for thoroughly assessing the surgical technique (Matsushima et al, 2020;Rossi et al, 2011). One strength of our study is the relatively large cohort for comparing the rates of adverse events.…”

A Home-Based, Post-Discharge Early Intervention Program Promotes Motor Development and Physical Growth in the Early Preterm Infants: A Prospective, Randomized Controlled Trial

“…Gross motor, ne motor, social development, adaptiveness, and language skills were the ve subdomains assessed in this study. An overall general DQ score was calculated by summing these subdomains, and more than 85 is considered normal (13).…”