Twin-twin transfusion syndrome: neurodevelopment of infants treated with laser surgery

Abstract

Objective To assess the neurodevelopmental functions of survivors of twin-twin transfusion syndrome (TTTS) treated by fetoscopic laser coagulation (FLC), during the first year of life, comparing them to a control group; and to verify the influence of specific variables on neurodevelopment. Method This was a prospective, longitudinal study. The sample comprised 33 monochorionic diamniotic twins who underwent FLC for treatment of TTTS and 22 full-term infants of single-fetus pregnancies. Bayley Scales of Infant and Toddler Development Screening Test were used for evaluation. Prenatal, perinatal and postnatal information were obtained. Results There was an increased frequency of infants in the TTTS group with inadequate performance compared to the control group. The identified variables (fetal donor, low economic income and cardiorespiratory disease) negatively impacted expressive communication and fine motor skills. Conclusion Although through follow-up is recommended in all TTTS survivors, particular attention is required for the high-risk group as defined in this study.

Twin-twin transfusion syndrome in the era of fetoscopic laser surgery: antenatal management, neonatal outcome and beyond

“…However, because of the decreasing trend in the rate of severe NDI, attention is shifting toward more subtle problems, including mild CP and neurocognitive impairments. Minor impairments can have a significant impact on the care and educational requirements of children and are reported in up to 30% of TTTS survivors [25,47,48,[88][89][90]. In order to gain more information on the exact burden and severity of NDI after laser surgery for TTTS, we encourage international collaboration to obtain larger sample sizes and statistical power, using a standardized follow-up regimen including uniform and clearly defined criteria for long-term neurodevelopmental impairment [91].…”

Twin amniotic fluid discordance below 26 weeks of gestation for predicting adverse outcomes

“…However, it is true that 11~14% of living twin children have an adverse neurological outcome after FLP [3]. In overseas reports, the proportion of adverse neurological outcome was 14~18%, almost the same as in Japan [4,5]. Investigations into the effects on neurological outcome after FLP are still ongoing [6].…”

Long-Term Neurodevelopmental Outcome of Monochorionic Twins after Laser Therapy or Umbilical Cord Occlusion for Twin-Twin Transfusion Syndrome

“…Selective feticide is another treatment option in certain cases [10][11][12][13][14][15]. Studies on the long-term neurodevelopmental outcome in children after TTTS are still limited, especially after selective feticide of the co-twin [11,[15][16][17]. Severe neurodevelopmental impairment (NDI) is reported to occur in 8-15% [11,15,17,18] of children after fetoscopic laser surgery or selective feticide and is believed to be influenced by TTTS itself [19], gestational age (GA) at delivery, and birthweight [20].…”

“…Studies on the long-term neurodevelopmental outcome in children after TTTS are still limited, especially after selective feticide of the co-twin [11,[15][16][17]. Severe neurodevelopmental impairment (NDI) is reported to occur in 8-15% [11,15,17,18] of children after fetoscopic laser surgery or selective feticide and is believed to be influenced by TTTS itself [19], gestational age (GA) at delivery, and birthweight [20]. Some studies suggest that twinning and monochorionicity may increase the risk of neurologic disabilities [21][22][23].…”