title: Cerebral injury and neurodevelopmental impairment after amnioreduction versus laser surgery in twin-twin transfusion syndrome: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To estimate the odds of severe cerebral injury and long-term neurodevelopmental impairment in monochorionic twins treated with amnioreduction versus laser surgery for twin-twin transfusion syndrome.
  
  
  METHODS
  A systematic review and meta-analysis of studies on cerebral injury and long-term impairment after amnioreduction versus laser surgery were conducted. Odds ratios (OR) with their 95% confidence interval (CI) were computed.
  
  
  RESULTS
  Electronic and manual search identified 63 references. Five studies were included for analysis. We found an ample seven-fold higher risk of severe cerebral injury in live-born children treated with amnioreduction compared to laser (OR 7.69, 95% CI 2.78-20.0, p = 0.00). In children surviving the neonatal period, the odds were three-times higher following amnioreduction (OR 3.23, 95% CI 1.45-7.14, p = 0.00). Although not significant, monochorionic twins treated with amnioreduction had higher odds of periventricular leukomalacia and intraventricular hemorrhage (OR 2.08, 95% CI 0.86-5.00, p = 0.10 and OR 3.56, 95% CI 0.82-14.29, p = 0.09). Unfortunately, there were insufficient long-term outcome data available to estimate the odds of neurodevelopmental impairment.
  
  
  CONCLUSIONS
  Amnioreduction is associated with an increased risk of severe cerebral injury compared to laser surgery in twin-twin transfusion syndrome. Our study highlights a lack of studies focusing on long-term neurodevelopmental outcome. Follow-up into childhood is indispensable to determine outcome in terms of motor, cognitive and socioemotional development.
authors.affiliation: Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. j.m.m.van_klink @lumc.nl
authors.forename: Jeanine M M
authors.initials: JM
authors.lastname: van Klink
authors.forename: Hendrik M
authors.initials: HM
authors.lastname: Koopman
authors.forename: Erik W
authors.initials: EW
authors.lastname: van Zwet
authors.forename: Dick
authors.initials: D
authors.lastname: Oepkes
authors.forename: Frans J
authors.initials: FJ
authors.lastname: Walther
authors.forename: Enrico
authors.initials: E
authors.lastname: Lopriore
mesh_terms: D000649:Amniocentesis / Q000009:adverse effects; D001930:Brain Injuries / Q000209:etiology* / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000503:physiopathology; D019299:Decompression, Surgical / Q000009:adverse effects*; D002658:Developmental Disabilities / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D017075:Laser Coagulation / Q000009:adverse effects*; D007969:Leukomalacia, Periventricular / Q000209:etiology / Q000503:physiopathology; D016017:Odds Ratio; D011247:Pregnancy; D012720:Severity of Illness Index