title: Fetal brain-sparing after laser surgery for twin-twin transfusion syndrome appears associated with two-year neurodevelopmental outcomes.
abstract: OBJECTIVE
  The cerebroplacental ratio (CPR) is a semi-quantitative marker for fetal brain-sparing. Our purpose was to measure the CPR at the time of treatment with selective laser photocoagulation of communicating vessels in gestations with twin-twin transfusion syndrome (TTTS) to test its association with neurological outcomes at approximately 2 years.
  
  
  METHODS
  One-hundred children treated for TTTS with laser surgery underwent neurodevelopmental assessment at age 2 years (within 6 weeks) via the Battelle Developmental Inventory 2nd Edition (BDI-2). The CPR was obtained 24 h before and after laser surgery. An abnormal CPR was categorically defined at <1.0. Multilevel linear regression was used to evaluate associations between CPR and neurodevelopment as assessed by the BDI-2.
  
  
  RESULTS
  Ninety-nine children had data available for analysis: 55 (56%) had normal CPR prior to laser surgery, and 62 (63%) had normal CPR following surgery. Post-laser CPR <1.0 was a risk factor for lower BDI-2 scores at age 2 years [98.1 (SD 11.5) vs 103.4 (SD 12.3) vs β = -0.23, p = 0.01]; this relationship remained significant after controlling for pre-surgical CPR and Quintero stage (adjusted β = -0.25, p = 0.01).
  
  
  CONCLUSIONS
  In this population, an abnormal CPR was associated with poorer 2-year neurodevelopmental outcomes. © 2015 John Wiley & Sons, Ltd.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California, USA.
authors.forename: Ramen H
authors.initials: RH
authors.lastname: Chmait
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California, USA.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Chon
authors.affiliation: Division of Hospital Medicine, Children's Hospital Los Angeles, USA.
authors.forename: Sheree M
authors.initials: SM
authors.lastname: Schrager
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California, USA.
authors.forename: Arlyn
authors.initials: A
authors.lastname: Llanes
authors.affiliation: Division of Pediatric Neuropsychology, Children's Hospital Los Angeles, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Hamilton
authors.affiliation: Department of Pediatrics, Division of General Pediatrics, Keck School of Medicine, University of Southern California, USA.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Vanderbilt
mesh_terms: D001921:Brain / Q000196:embryology*; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005330:Fetofetal Transfusion / Q000150:complications / Q000601:surgery*; D005332:Fetoscopy; D005500:Follow-Up Studies; D006801:Humans; D017075:Laser Coagulation; D016014:Linear Models; D008297:Male; D009483:Neuropsychological Tests; D010920:Placenta / Q000196:embryology*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors