title: Improvement in neurodevelopmental outcome in survivors of twin-twin transfusion syndrome treated with laser surgery.
abstract: OBJECTIVE
  To compare the incidence of neurodevelopmental impairment in surviving children from pregnancies with twin-twin transfusion syndrome (TTTS) treated with laser surgery between 2 time periods.
  
  
  METHODS
  We compared the neurodevelopmental outcome between the first consecutive cohort of TTTS pregnancies treated with laser surgery from 2000 to 2005, with a cohort treated between 2008 and 2010. Neurologic, cognitive, and motor development was evaluated using Bayley scales at 2 years of age corrected for prematurity.
  
  
  RESULTS
  A total of 229 twin pregnancies were treated with laser surgery, 113 in the first cohort and 106 in the recent cohort. Overall survival increased from 70% (158/226) to 80% (170/212) (P = .014). The incidence of neurodevelopmental impairment decreased from 18% (28/152) to 6% (10/155) (P < .01). In multivariate analysis, severe cerebral injury at birth was independently associated with neurodevelopmental impairment (odds ratio, 34.86; 95% confidence interval, 11.83-102.75; P < .01).
  
  
  CONCLUSIONS
  Overall survival in TTTS has improved over time, with a concomitant reduction in the incidence of neurodevelopmental impairment. Research focused on prevention of cerebral injury is needed to further improve outcomes of these complicated twin pregnancies.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Jeanine M M
authors.initials: JM
authors.lastname: van Klink
authors.affiliation: Department of Clinical Psychology, Faculty of Social Sciences, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Hendrik M
authors.initials: HM
authors.lastname: Koopman
authors.affiliation: Department of Biostatistics, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Erik W
authors.initials: EW
authors.lastname: van Zwet
authors.affiliation: Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Middeldorp
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Frans J
authors.initials: FJ
authors.lastname: Walther
authors.affiliation: Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Dick
authors.initials: D
authors.lastname: Oepkes
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Enrico
authors.initials: E
authors.lastname: Lopriore
mesh_terms: D001930:Brain Injuries / Q000453:epidemiology / Q000209:etiology*; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005330:Fetofetal Transfusion / Q000150:complications* / Q000401:mortality / Q000601:surgery; D005332:Fetoscopy / Q000009:adverse effects* / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D059285:Pregnancy, Twin / Q000502:physiology*; D012044:Regression Analysis; D017741:Survivors / Q000706:statistics & numerical data
keywords: laser surgery; neurodevelopmental outcome; twin-twin transfusion syndrome