title: Long-term neurodevelopmental outcome after selective feticide in monochorionic pregnancies.
abstract: OBJECTIVE
  To assess the incidence of and risk factors for adverse long-term neurodevelopmental outcome in complicated monochorionic pregnancies treated with selective feticide at our centre between 2000 and 2011.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  National referral centre for fetal therapy (Leiden University Medical Centre, the Netherlands).
  
  
  METHODS
  Neurodevelopmental outcome was assessed in 74 long-term survivors.
  
  
  METHODS
  Children, at least 2 years of age, underwent an assessment of neurologic, motor and cognitive development using standardised psychometric tests and the parents completed a behavioural questionnaire.
  
  
  METHODS
  A composite outcome termed neurodevelopmental impairment including cerebral palsy (GMFCS II-V), cognitive and/or motor test score of <70, bilateral blindness or bilateral deafness requiring amplification.
  
  
  RESULTS
  A total of 131 monochorionic pregnancies were treated with selective feticide at the Leiden University Medical Centre. Overall survival rate was 88/131 (67%). Long-term outcome was assessed in 74/88 (84%). Neurodevelopmental impairment was detected in 5/74 [6.8%, 95% confidence interval (CI), 1.1-12.5] of survivors. Overall adverse outcome, including perinatal mortality or neurodevelopmental impairment was 48/131 (36.6%). In multivariate analysis, parental educational level was associated with cognitive test scores (regression coefficient B 3.9, 95% CI 1.8-6.0). Behavioural problems were reported in 10/69 (14.5%).
  
  
  CONCLUSIONS
  Adverse long-term outcome in survivor twins of complicated monochorionic pregnancies treated with selective feticide appears to be more prevalent than in the general population. Cognitive test scores were associated with parental educational level.
  
  
  CONCLUSIONS
  Neurodevelopmental impairment after selective feticide was detected in 5/74 (6.8%, 95% CI 1.1-12.5) of survivors.
authors.affiliation: Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Jmm
authors.initials: J
authors.lastname: van Klink
authors.affiliation: Clinical Psychology, Faculty of Social Sciences, Leiden University, Leiden, the Netherlands.
authors.forename: H M
authors.initials: HM
authors.lastname: Koopman
authors.affiliation: Division of Fetal Therapy, Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Middeldorp
authors.affiliation: Division of Fetal Therapy, Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: F J
authors.initials: FJ
authors.lastname: Klumper
authors.affiliation: Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Rijken
authors.affiliation: Division of Fetal Therapy, Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Oepkes
authors.affiliation: Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Lopriore
mesh_terms: D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology; D002675:Child, Preschool; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D065886:Neurodevelopmental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D010290:Parents; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal; D059285:Pregnancy, Twin; D011446:Prospective Studies; D017741:Survivors
keywords: Follow-up; monochorionic pregnancy; neurodevelopment; outcome; selective feticide