Long-term neurodevelopmental outcome after intrauterine laser treatment for severe twin-twin transfusion syndrome

doi:10.1067/mob.2003.202

American Journal of Obstetrics and Gynecology

Volume 188, Issue 4, April 2003, Pages 876-880

https://doi.org/10.1067/mob.2003.202 Get rights and content

Abstract

Objective: The purpose of this study was to investigate long-term neurodevelopmental outcome after intrauterine laser treatment for twin-twin transfusion syndrome. Study Design: All 89 surviving infants who were treated between January 1995 and May 1997 were investigated in a single center. Seventy-five children were tested with the Griffiths' Developmental Test Scales at a median age of 21 months; 14 children (median age, 34 months) were tested with the Snijders-Oomen-Non-Verbal-Intelligence Test. All children underwent a detailed standardized physical and neurologic examination. Results: Sixty-nine infants (78%) showed a normal development (group I), 10 infants (11%) had minor neurologic deficiencies (group II), and 10 infants (11%) had major neurologic deficiencies (group III). No difference between recipient and donor status was observed (P =.93). There was a trend toward a more favorable outcome for those infants who were born as twins (53 infants [81%] in group I and 5 infants [8%] in group III) compared with singleton survivors after intrauterine death of the cotwin (16 infants [67%] in group I and 5 infants [21%] in group III); however, the difference was not significant (P =.12). Conclusion: After intrauterine laser treatment for twin-twin transfusion syndrome, 78% of the children had a normal neurodevelopmental status, 11% of the children had minor neurologic deficiencies, and 11% of the children had major neurologic deficiencies, at a median age of 22 months. (Am J Obstet Gynecol 2003;188:876-80.)

Section snippets

Methods

We investigated a group of infants from Germany, Austria, and The Netherlands after prenatal endoscopic laser treatment at the Department of Prenatal Diagnosis and Therapy, Barmbek Hospital, Hamburg, Germany (January 1995 to May 1997). The survival rate and the obstetric outcome of these pregnancies has been reported previously.¹ In all 73 consecutive pregnancies, the diagnosis of severe TTTS was made because of the combination of single monochorionic placenta, polyhydramnios and

Results

The results for all infants are grouped in three categories. Tables I and II give a summary the results and give details concerning recipient or donor, twin or singleton, twin recipient or twin donor, and singleton recipient or singleton donor status for all infants who were born alive after TTTS.

. Summarized results of the neurologic and developmental outcome (groups I-III)

Infant characteristic	No.	Outcome group (No.)
Infant characteristic	No.	I	II	III
All survivors	89 (100%)	69 (78%)	10 (11%)	10 (11%)
Former recipients	51 (100%)	40

Comment

We present a prospective follow-up study of twins who survived fetal TTTS after prenatal treatment by laser coagulation of the communicating vessels. A 100% follow-up rate was achieved. Seventy-eight percent of all children showed normal development and no clinically detectable neurologic or developmental abnormality at the age of 14 to 44 months.

Recently, a staging system for TTTS has been introduced that allows for the grading of the severity of the disease by standardized criteria.¹⁴ Thus,

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^☆: Travel expenses of the families were covered by a fund from Milupa AG, Friedrichsdorf, Germany, and Siemens AG, Nuremberg, Germany.

^☆☆: Reprint requests: Peter Bartmann, MD, PhD, Department of Neonatology, University Children's Hospital Bonn, Adenauerallee 119, D-53113 Bonn, Germany. Email: [email protected]

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Editor's ChoiceLong-term neurodevelopmental outcome after intrauterine laser treatment for severe twin-twin transfusion syndrome☆,☆☆

Abstract

Section snippets

Methods

Results

Comment

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Eur J Obstet Gynecol

Early Hum Dev

Am J Obstet Gynecol

Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Editor's Choice
Long-term neurodevelopmental outcome after intrauterine laser treatment for severe twin-twin transfusion syndrome☆,☆☆