Improvement in neurodevelopmental outcome in survivors of twin-twin transfusion syndrome treated with laser surgery

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• 作者：Jeanine M.M. van Klink ; MSc^a ; Hendrik M. Koopman ; PhD^b ; Erik W. van Zwet ; PhD^c ; Johanna M. Middeldorp ; MD ; PhD^d ; Frans J. Walther ; MD ; PhD^a ; Dick Oepkes ; MD ; PhD^d ; Enrico Lopriore ; MD ; PhD^a
• 关键词：laser surgery ; neurodevelopmental outcome ; twin-twin transfusion syndrome
• 刊名：American Journal of Obstetrics and Gynecology
• 出版年：June 2014
• 年：2014
• 卷：210
• 期：6
• 页码：540.e1-540.e7
• 全文大小：409 K

文摘

To compare the incidence of neurodevelopmental impairment in surviving children from pregnancies with twin-twin transfusion syndrome (TTTS) treated with laser surgery between 2 time periods.

Study Design

We compared the neurodevelopmental outcome between the first consecutive cohort of TTTS pregnancies treated with laser surgery from 2000 to 2005, with a cohort treated between 2008 and 2010. Neurologic, cognitive, and motor development was evaluated using Bayley scales at 2 years of age corrected for prematurity.

Results

A total of 229 twin pregnancies were treated with laser surgery, 113 in the first cohort and 106 in the recent cohort. Overall survival increased from 70% (158/226) to 80% (170/212) (P = .014). The incidence of neurodevelopmental impairment decreased from 18% (28/152) to 6% (10/155) (P < .01). In multivariate analysis, severe cerebral injury at birth was independently associated with neurodevelopmental impairment (odds ratio, 34.86; 95% confidence interval, 11.83–102.75; P < .01).

Conclusion

Overall survival in TTTS has improved over time, with a concomitant reduction in the incidence of neurodevelopmental impairment. Research focused on prevention of cerebral injury is needed to further improve outcomes of these complicated twin pregnancies.