title: Long term developmental outcomes of pre-school age children following laser surgery for twin-to-twin transfusion syndrome.
abstract: BACKGROUND
  Laser therapy is now a well recognised treatment for twin-to-twin transfusion syndrome (TTTS). We investigated the early childhood neurodevelopmental outcome of children post laser treatment for TTTS in our centre.
  
  
  METHODS
  Children of women who had laser therapy for TTTS between March 2006 and June 2008 were assessed at 30-69 months of age with WPPSI-III and a general health questionnaire. Major neurodevelopmental impairment (NDI) was reported as IQ<70 or cerebral palsy (CP). Borderline cognitive impairment was defined by IQ 70-79.
  
  
  RESULTS
  Amongst the 37 pregnancies treated, 62 infants were discharged home and the overall foetal survival rate was 84%. A total of 50 children (84%) from 31 pregnancies were assessed. Average age at assessment was 47 months. Two children with late treatment of congenital hypothyroidism were excluded. The majority of pregnancies were Quintero Stage III (74%). There was a significant trend for worse outcome with higher Quintero stage. The average gestational age at birth was 32 weeks. The majority (39, 78%) of children were found to be neurodevelopmentally normal; 9 (18%) had borderline cognitive development; and 2 (4%) had a major NDI, including one with cerebral palsy (2%).
  
  
  CONCLUSIONS
  There was a modest level of neurocognitive impairment post laser therapy for TTTS, mainly borderline cognitive development, lesser so major NDI. There was a low incidence of cerebral palsy. Routine developmental and neurological follow-up of these children is recommended.
authors.affiliation: Royal Hospital for Women, Randwick, New South Wales, Australia.
authors.forename: J
authors.initials: J
authors.lastname: McIntosh
authors.affiliation: Royal Hospital for Women, Randwick, New South Wales, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Meriki
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Joshi
authors.affiliation: Royal Hospital for Women, Randwick, New South Wales, Australia.
authors.forename: V
authors.initials: V
authors.lastname: Biggs
authors.affiliation: Royal Hospital for Women, Randwick, New South Wales, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
authors.forename: A W
authors.initials: AW
authors.lastname: Welsh
authors.affiliation: Royal Hospital for Women, Randwick, New South Wales, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Challis
authors.affiliation: Royal Hospital for Women, Randwick, New South Wales, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia. Electronic address: k.lui@unsw.edu.au.
authors.forename: K
authors.initials: K
authors.lastname: Lui
mesh_terms: D000328:Adult; D002547:Cerebral Palsy / Q000453:epidemiology; D002657:Child Development; D002675:Child, Preschool; D003072:Cognition Disorders / Q000453:epidemiology; D002658:Developmental Disabilities / Q000453:epidemiology*; D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery*; D005332:Fetoscopy; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007361:Intelligence Tests; D053685:Laser Therapy; D011247:Pregnancy; D016896:Treatment Outcome
keywords: Developmental outcome; Laser therapy; Twin-to-twin transfusion syndrome