Risk factors for neurodevelopment impairment in twin-twin transfusion syndrome treated with fetoscopic laser surgery.
OBJECTIVE
To estimate the risk factors for adverse long-term neurodevelopment outcome in twin-twin transfusion syndrome treated with laser surgery.


METHODS
Twin-twin transfusion syndrome cases treated with laser surgery at three European centers from August 2000 to December 2005 were included in this case-control study. Neurological, mental, and psychomotor development (using the Bayley Scales of Infant Development, 2nd edition) was evaluated at 2 years of age.


RESULTS
A total of 212 twin-twin transfusion syndrome pregnancies were treated with laser surgery during the study period. Overall mortality rate was 30% (129 of 424). Seventeen children (6%) were lost to follow-up. Long-term outcome was assessed in 278 infants. The incidence of neurodevelopment impairment was 18% (50 of 278). Four risk factors were found to be significantly associated with increased risk for neurodevelopment impairment: greater gestational age at laser surgery (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.00-1.69; P=.05), higher Quintero stage (OR 3.55 for each increment in stage, 95% CI 1.07-11.82, P=.04), lower gestational age at birth (OR 1.39 for each week, 95% CI 1.06-1.81; P=.01), and lower birth weight (OR 1.18 for each 100-g decrease, 95% CI 1.05-1.32; P<.01). In a multivariable analysis, lower gestational age at birth was the only factor independently associated with neurodevelopmental impairment (OR 1.33 for each week, 95% CI 1.05-1.67, P=.02).


CONCLUSIONS
Neurodevelopment impairment in twin- twin transfusion syndrome survivors treated with laser surgery is associated with advanced gestational age at laser surgery, low gestational age at birth, low birth weight, and high Quintero stage.


METHODS
II.
Lopriore
Enrico
E
Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands. e.lopriore@lumc.nl
Ortibus
Els
E
Acosta-Rojas
Ruthy
R
Le Cessie
Saskia
S
Middeldorp
Johanna M
JM
Oepkes
Dick
D
Gratacos
Eduard
E
Vandenbussche
Frank P H A
FP
Deprest
Jan
J
Walther
Frans J
FJ
Lewi
Liesbeth
L
D016022:Case-Control Studies; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000209:etiology*; D005260:Female; D005330:Fetofetal Transfusion / Q000150:complications* / Q000601:surgery*; D005332:Fetoscopy; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D053685:Laser Therapy; D016017:Odds Ratio; D011247:Pregnancy