title: Prevalence and risk factors of cerebral lesions in neonates after laser surgery for twin-twin transfusion syndrome.
abstract: OBJECTIVE
  To identify risk factors for cerebral lesions among survivors of twin-twin transfusion syndrome treated with laser surgery.
  
  
  METHODS
  A multilevel regression analysis examined risk factors for neonatal cerebral lesions identified by imaging. Imaging was routine in "high-risk survivors," defined as those delivered at <32 weeks' gestation, and by clinical indications if born later. Severe lesions were defined as: intraventricular hemorrhage grade III-IV, cystic periventricular leukomalacia, ventriculomegaly and/or hydrocephalus, microcephaly, infarctions, porencephalic/Dandy-Walker cysts, or bilateral other cysts.
  
  
  RESULTS
  For 262 consecutive laser-treated twin-twin transfusion syndrome patients, 18 neonates had severe lesions identified among 427 individual survivors (4.2%) and 242 "high-risk survivors" (7.4%). Forty-six newborns had any cerebral lesion, resulting in lesion rates of 10.8%-19.0%. Delivery <32 weeks' (odds ratio, 4.95; P < .001) and <28 weeks' (odds ratio, 6.25; P < .001) gestation were associated with increased likelihood of any cerebral lesion.
  
  
  CONCLUSIONS
  This cohort showed low rates (4-7%) of severe neonatal cerebral lesions, with prematurity being the primary risk factor.
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, Keck School of Medicin, University of Southern California, Los Angeles, CA, USA.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Vanderbilt
authors.forename: Sheree M
authors.initials: SM
authors.lastname: Schrager
authors.forename: Arlyn
authors.initials: A
authors.lastname: Llanes
authors.forename: Ramen H
authors.initials: RH
authors.lastname: Chmait
mesh_terms: D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery*; D005332:Fetoscopy / Q000009:adverse effects; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology / Q000209:etiology*; D007231:Infant, Newborn; D007234:Infant, Premature; D020300:Intracranial Hemorrhages / Q000453:epidemiology / Q000209:etiology*; D053685:Laser Therapy / Q000009:adverse effects*; D007969:Leukomalacia, Periventricular / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors