Neurodevelopmental outcome in twin anemia–polycythemia sequence after laser surgery for twin–twin transfusion syndrome. (3rd August 2014)

• Record Type: Journal Article
• Authors: Slaghekke, F.; van Klink, J. M. M.; Koopman, H. M.; Middeldorp, J. M.; Oepkes, D.; Lopriore, E.
• Is Part Of: Ultrasound in obstetrics & gynecology. Volume 44:Number 3(2014:Sep.)
• Page Start: 316
• Page End: 321
• Publication Date: 2014-08-03
• Subjects: Ultrasonics in obstetrics -- Periodicals; Generative organs, Female -- Diseases -- Diagnosis -- Periodicals; Diagnosis, Ultrasonic -- Periodicals; Genital Diseases, Female -- ultrasonography -- Periodicals; Ultrasonography, Prenatal -- Periodicals; 618.047543
• DOI: 10.1002/uog.13387
• Languages: English
• ISSNs: 0960-7692

Abstract

<abstract abstract-type="main" id="uog13387-abs-0001"> <title>ABSTRACT</title> <sec id="uog13387-sec-0001" sec-type="section"> <title>Objective</title> <p id="uog13387-para-0002">To evaluate the long‐term neurodevelopmental outcome in children who developed twin anemia–polycythemia sequence (TAPS) after fetoscopic laser surgery for twin–twin transfusion syndrome (TTTS).</p> </sec> <sec id="uog13387-sec-0002" sec-type="section"> <title>Methods</title> <p id="uog13387-para-0003">Neurological, motor and cognitive development was assessed in a consecutive cohort of TTTS survivors treated with laser surgery between 2004 and 2011 and complicated by post‐laser TAPS. Primary outcome was neurodevelopmental impairment, a composite outcome including any of the following: cerebral palsy, bilateral deafness, blindness, severe motor and/or cognitive developmental delay (>2 SD below the mean). A risk analysis on cognitive outcome was performed.</p> </sec> <sec id="uog13387-sec-0003" sec-type="section"> <title>Results</title> <p id="uog13387-para-0004">During the study period, 33/306 (11%) monochorionic twin pairs developed TAPS after laser surgery for TTTS. Survival was 53/66 (80%). Long‐term outcome was assessed in 47/53 (89%) children. The incidence of neurodevelopmental impairment was 4/47 (9%), occurring in one donor (1/20; 5%) and three recipients (3/27; 11%) (<italic>P</italic> = 0.63). Mild‐to‐moderate cognitive delay, i.e. scores below 85, was detected in 8/47 (17%) children. Risk factors for low cognitive scores were low gestational age at birth (<italic>P</italic> = 0.02) and low birth weight (<italic>P</italic> < 0.01). The lowest cognitive scores were detected in the subgroup of TAPS survivors treated with intrauterine transfusion (median score, 82.5).</p> </sec> <sec id="uog13387-sec-0004" sec-type="section"> <title>Conclusions</title> <p id="uog13387-para-0005">Neurodevelopmental impairment and cognitive delay were found in almost one in five children surviving post‐laser TAPS. Better treatment and, ideally, prevention of this complication after laser treatment for TTTS is urgently needed. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd</p> </sec> </abstract>