title: Neurodevelopmental outcome in twin anemia-polycythemia sequence after laser surgery for twin-twin transfusion syndrome.
abstract: OBJECTIVE
  To evaluate the long-term neurodevelopmental outcome in children who developed twin anemia-polycythemia sequence (TAPS) after fetoscopic laser surgery for twin-twin transfusion syndrome (TTTS).
  
  
  METHODS
  Neurological, motor and cognitive development was assessed in a consecutive cohort of TTTS survivors treated with laser surgery between 2004 and 2011 and complicated by post-laser TAPS. Primary outcome was neurodevelopmental impairment, a composite outcome including any of the following: cerebral palsy, bilateral deafness, blindness, severe motor and/or cognitive developmental delay (>2 SD below the mean). A risk analysis on cognitive outcome was performed.
  
  
  RESULTS
  During the study period, 33/306 (11%) monochorionic twin pairs developed TAPS after laser surgery for TTTS. Survival was 53/66 (80%). Long-term outcome was assessed in 47/53 (89%) children. The incidence of neurodevelopmental impairment was 4/47 (9%), occurring in one donor (1/20; 5%) and three recipients (3/27; 11%) (P=0.63). Mild-to-moderate cognitive delay, i.e. scores below 85, was detected in 8/47 (17%) children. Risk factors for low cognitive scores were low gestational age at birth (P=0.02) and low birth weight (P<0.01). The lowest cognitive scores were detected in the subgroup of TAPS survivors treated with intrauterine transfusion (median score, 82.5).
  
  
  CONCLUSIONS
  Neurodevelopmental impairment and cognitive delay were found in almost one in five children surviving post-laser TAPS. Better treatment and, ideally, prevention of this complication after laser treatment for TTTS is urgently needed.
authors.affiliation: Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Slaghekke
authors.forename: J M M
authors.initials: JM
authors.lastname: van Klink
authors.forename: H M
authors.initials: HM
authors.lastname: Koopman
authors.forename: J M
authors.initials: JM
authors.lastname: Middeldorp
authors.forename: D
authors.initials: D
authors.lastname: Oepkes
authors.forename: E
authors.initials: E
authors.lastname: Lopriore
mesh_terms: D000740:Anemia / Q000453:epidemiology / Q000601:surgery*; D001766:Blindness / Q000453:epidemiology / Q000209:etiology*; D001805:Blood Transfusion, Intrauterine / Q000009:adverse effects*; D002547:Cerebral Palsy / Q000453:epidemiology / Q000209:etiology*; D002675:Child, Preschool; D003638:Deafness / Q000453:epidemiology / Q000209:etiology*; D002658:Developmental Disabilities / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005330:Fetofetal Transfusion / Q000150:complications* / Q000453:epidemiology / Q000601:surgery*; D005332:Fetoscopy / Q000009:adverse effects / Q000706:statistics & numerical data; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D053685:Laser Therapy / Q000009:adverse effects*; D008297:Male; D016017:Odds Ratio; D011086:Polycythemia / Q000453:epidemiology / Q000601:surgery*; D011247:Pregnancy; D059285:Pregnancy, Twin; D017741:Survivors
keywords: cognitive development; laser surgery; neurodevelopmental outcome; twin anemia-polycythemia sequence; twin-twin transfusion syndrome