title: Evaluation of long-term neurodevelopment in twin-twin transfusion syndrome after laser therapy.
abstract: OBJECTIVE
  The primary objective of our study was to evaluate the long-term neurodevelopment outcome after laser surgery for twin-twin transfusion syndrome (TTTS). The secondary objective was to identify perinatal prognostic factors associated with neurodevelopmental impairment.
  
  
  METHODS
  This was a single-center cohort prospective study carried out in pregnancies complicated by TTTS and treated by laser. Neurodevleopmental assesment included the administration of Ages and Stages Questionnaires® (ASQ), for the infants between 2 and 5 years of age.
  
  
  RESULTS
  A total of 187 patients underwent a laser for TTTS between 2004 and 2013. Significant brain lesions were detected in eight (2.9%) cases by ultrasound and/or magnetic resonance imaging including intraventricular hemorrhage, periventricular leukomalacia, and porencephaly. Questionnaires were administered to 126 children (50.4%) at 24 months or older at the moment of testing. There were 13.5% of those infants who had an abnormal ASQ (established as one area or more scoring < 2 SD) at 3.6 years ±1.3 follow-up. There was a higher rate of abnormal ASQ among the infants with a birth weight below the fifth percentile (p = 0.036).
  
  
  CONCLUSIONS
  Twin-twin transfusion syndrome is associated with a risk of abnormal neurological development, even in case of laser surgery. Further studies are necessary to identify the risk factors for neurological impairment. © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France.|INSERM, UMR-S 1121, 'Biomatériaux et Bioingénierie', Strasbourg, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sananès
authors.affiliation: Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Victor
authors.initials: V
authors.lastname: Gabriele
authors.affiliation: Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Anne Sophie
authors.initials: AS
authors.lastname: Weingertner
authors.affiliation: Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Ruano
authors.affiliation: Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Sanz-Cortes
authors.affiliation: Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Gaudineau
authors.affiliation: Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Langer
authors.affiliation: Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Israël
authors.initials: I
authors.lastname: Nisand
authors.affiliation: Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Chérif Youssef
authors.initials: CY
authors.lastname: Akladios
authors.affiliation: Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Favre
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002552:Cerebral Ventricles / Q000000981:diagnostic imaging; D002675:Child, Preschool; D015331:Cohort Studies; D004453:Echoencephalography; D005260:Female; D046128:Fetal Therapies / Q000379:methods*; D005330:Fetofetal Transfusion / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D007969:Leukomalacia, Periventricular / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D065886:Neurodevelopmental Disorders / Q000453:epidemiology / Q000503:physiopathology*; D065708:Porencephaly / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014430:Twins, Monozygotic; D055815:Young Adult