Long-term neurodevelopmental outcome in twin-to-twin transfusion syndrome.
OBJECTIVE
The purpose of this study was to determine the long-term neurodevelopmental outcome in children after twin-to-twin transfusion syndrome.


METHODS
Maternal and neonatal medical records of all twin-to-twin transfusion syndrome patients who were admitted to our center between 1990 and 1998 were reviewed. Neurologic and mental development at school age was assessed during a home visit in all twin-to-twin transfusion syndrome survivors.


RESULTS
A total of 33 pregnancies with twin-to-twin transfusion syndrome were identified. Four couples opted for termination of pregnancy. All other pregnancies were treated conservatively, 18 pregnancies (62%) with serial amnioreductions and 11 pregnancies (38%) without intrauterine interventions. Mean gestational age at delivery was 28.6 weeks (range, 20-37 weeks). The perinatal mortality rate was 50% (29/58 infants). The birth weight of the donor twins was less than the recipient twins (P<.001). Systolic blood pressure at birth was lower in donors than in recipients (P=.023), and donors required inotropic support postnatally more frequently than did recipients (P=.008). The incidence of hypertension at birth was higher in recipients than in donors (P=.038). Abnormal cranial ultrasonographic findings were reported in 41% of the neonates (12/29 neonates). All long-term survivors (n=29 neonates) were assessed during a home visit. Mean gestational age at birth of the surviving twin was 31.6 weeks (range, 25-37 weeks). The mean age at follow-up was 6.2 years (range, 4-11 years). The incidence of cerebral palsy was 21% (6/29 infants). Five of 6 children with cerebral palsy had an abnormal mental development. The incidence of cerebral palsy in the group of survivors who were treated with serial amnioreduction was 26% (5/19 infants). Four children were born after the intrauterine fetal demise of their co-twin, 2 of which had cerebral palsy.


CONCLUSIONS
The incidence of adverse neurodevelopmental outcome in twin-to-twin transfusion syndrome survivors is high, especially after the intrauterine fetal demise of a co-twin.
Lopriore
Enrico
E
Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.
Nagel
Helene T C
HT
Vandenbussche
Frank P H A
FP
Walther
Frans J
FJ
D001921:Brain / Q000002:abnormalities; D002547:Cerebral Palsy / Q000453:epidemiology / Q000209:etiology; D002658:Developmental Disabilities / Q000209:etiology*; D004200:Diseases in Twins; D005260:Female; D005313:Fetal Death; D005330:Fetofetal Transfusion / Q000150:complications*; D006801:Humans; D006973:Hypertension / Q000209:etiology; D015994:Incidence; D007226:Infant Mortality; D007231:Infant, Newborn; D008607:Intellectual Disability / Q000209:etiology; D009422:Nervous System Diseases / Q000209:etiology*; D011247:Pregnancy; D011256:Pregnancy Outcome