The relationship between preoperative fetal head circumference and 2‐year cognitive performance after laser surgery for twin‐twin transfusion syndrome. (24th January 2018)

• Record Type: Journal Article
• Authors: Chon, Andrew H.; Mamey, Mary Rose; Schrager, Sheree M.; Vanderbilt, Douglas L.; Chmait, Ramen H.
• Is Part Of: Prenatal diagnosis. Volume 38:Number 3(2018)
• Page Start: 173
• Page End: 178
• Publication Date: 2018-01-24
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.5204
• Languages: English
• ISSNs: 0197-3851

Abstract

Abstract: Objective: To determine the relationship between preoperative fetal head circumference (HC) and cognitive performance among children treated with laser surgery for twin‐twin transfusion syndrome (TTTS). Methods: Donor and recipient twin HCs were measured preoperatively (16–26 weeks' gestation) and at 2 years corrected age. Multilevel multivariate regression models were used to test pregnancy and child‐level risk factors for lower Battelle Developmental Inventory Second Edition (BDI‐2) scores. A repeated‐measures ANOVA was used to examine HC growth among recipients and donors between preoperative and 2 years. Results: Ninety‐nine children were evaluated. The average BDI‐2 score for the cohort was 101.4 (SD = 12.2). After controlling for covariates, larger preoperative HC percentiles were significantly associated with an increase in total BDI‐2 scores (β = 0.29; P < 0.001), where a 12.5% increase in preoperative HC percentile was associated with 1‐point increase in total BDI‐2 score. The mean recipient and donor twin HC percentiles preoperatively and at age 2 years were 51 st percentile vs 20 th percentile ( P = .050) and 60 th percentile vs 49 th percentile ( P = .676), respectively. Conclusion: Smaller preoperative HC percentiles identified children at risk of lower, but still within normal range, total BDI‐2 scores. The discordance in HC percentiles between the donor and recipient twin decreased after laser surgery. Abstract : What's already known? Smaller head circumference (HC) at 2 years of age after laser surgery for twin‐twin transfusion syndrome (TTTS) is associated with lower overall cognitive performance. What does this study add? Smaller fetal HC at the preoperative ultrasound done before laser surgery for TTTS is also associated with lower overall cognitive performance. HC percentiles are smaller for the donor compared with the recipient at the preoperative assessment, but this discordance decreases significantly at 2 years of age.