The neurological outcomes of surviving twins in severe twin-twin transfusion syndrome treated by fetoscopic laser photocoagulation at a newly established center.
OBJECTIVE
To evaluate the incidence and predictive factors of poor neurological outcome in survivors of twin-to-twin transfusion syndrome (TTTS) treated with fetoscopic laser photocoagulation (FLP).


METHODS
Brain magnetic resonance imaging (MRI) and neurodevelopmental assessment were performed at a corrected age of 1 year in survivors of TTTS treated by FLP. Severe neurological abnormality was defined as either the presence of severe clinical neurodevelopmental disability or severe anomalies, visualized on MRI of the brain.


RESULTS
In a consecutive series of 46 cases treated by FLP, the total survival rate was 66.3%; survival of at least one was 80.4%. Severe neurodevelopment disability was 6.7 % (4/59) and the presence of a severe anomaly on brain imaging was 8.8% (5/57), which combined to a clinical or MRI abnormality rate of 10.5% (6/57). Univariate analysis revealed that early gestational age at delivery was the most significant predictor. However, the multiple logistic regression model did not identify any significant variables.


CONCLUSIONS
In this small series, we determined a rate of clinical neurologic impairment rate at the age of 1 year of 6.7%, which compares to what has been published.
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan. j12054@cgmh.org.tw
Yao-Lung
YL
Chang
An-Shine
AS
Chao
Shuenn-Dyh
SD
Chang
Reyin
R
Lien
Peter C C
PC
Hsieh
Chao-Nin
CN
Wang
D000328:Adult; D004200:Diseases in Twins / Q000453:epidemiology*; D005260:Female; D005328:Fetal Viability / Q000502:physiology; D005330:Fetofetal Transfusion / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D005332:Fetoscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology; D017075:Laser Coagulation / Q000009:adverse effects / Q000379:methods; D008028:Light Coagulation / Q000009:adverse effects / Q000379:methods; D008430:Maternal-Child Health Centers; D009422:Nervous System Diseases / Q000151:congenital / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011379:Prognosis; D016896:Treatment Outcome; D014427:Twins