Fetal brain‐sparing after laser surgery for twin‐twin transfusion syndrome appears associated with two‐year neurodevelopmental outcomes4. (22nd November 2015)

• Record Type: Journal Article
• Authors: Chmait, Ramen H.; Chon, Andrew H.; Schrager, Sheree M.; Llanes, Arlyn; Hamilton, Anita; Vanderbilt, Douglas L.
• Is Part Of: Prenatal diagnosis. Volume 36:Number 1(2016)
• Page Start: 63
• Page End: 67
• Publication Date: 2015-11-22
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.4713
• Languages: English
• ISSNs: 0197-3851

Abstract

Abstract: Objective: The cerebroplacental ratio (CPR) is a semi‐quantitative marker for fetal brain‐sparing. Our purpose was to measure the CPR at the time of treatment with selective laser photocoagulation of communicating vessels in gestations with twin‐twin transfusion syndrome (TTTS) to test its association with neurological outcomes at approximately 2 years. Methods: One‐hundred children treated for TTTS with laser surgery underwent neurodevelopmental assessment at age 2 years (within 6 weeks) via the Battelle Developmental Inventory 2nd Edition (BDI‐2). The CPR was obtained 24 h before and after laser surgery. An abnormal CPR was categorically defined at <1.0. Multilevel linear regression was used to evaluate associations between CPR and neurodevelopment as assessed by the BDI‐2. Results: Ninety‐nine children had data available for analysis: 55 (56%) had normal CPR prior to laser surgery, and 62 (63%) had normal CPR following surgery. Post‐laser CPR <1.0 was a risk factor for lower BDI‐2 scores at age 2 years [98.1 (SD 11.5) vs 103.4 (SD 12.3) vs β = −0.23, p = 0.01]; this relationship remained significant after controlling for pre‐surgical CPR and Quintero stage (adjusted β = −0.25, p = 0.01). Conclusions: In this population, an abnormal CPR was associated with poorer 2‐year neurodevelopmental outcomes. © 2015 John Wiley & Sons, Ltd. Abstract : What's already known about this topic? The cerebroplacental ratio (CPR) (middle cerebral artery pulsatility index divided by the umbilical artery pulsatility index) has been used to identify fetuses with decreased cerebral vascular resistance, a phenomenon often referred to as 'brain‐sparing'. CPR <1.0 has been associated with adverse neurological outcomes in singleton gestations with intrauterine growth restriction and in appropriately grown singleton gestations close to term. Limited data exist regarding the relationship between CPR and neurological outcomes. What does this study add? Among twin‐twin transfusion syndrome patients treated by laser photocoagulation, an abnormal post‐laser CPR (<1.0) was associated with poorer long‐term neurodevelopmental outcomes.