177: Two-year neurodevelopmental outcomes in children treated with laser surgery for twin-twin transfusion syndrome (TTTS)

Abstract

children treated with laser surgery for twin-twin transfusion syndrome (TTTS) Douglas Vanderbilt, Sheree Schrager, Arlyn Llanes, Anita Hamilton, Istvan Seri, Ramen Chmait Childrens Hospital Los Angeles, USC Center for Excellence in Developmental Disabilities, Los Angeles, CA, Childrens Hospital Los Angeles, Division of Adolescent Medicine, Los Angeles, CA, Keck School of Medicine, University of Southern California, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Los Angeles, CA, Childrens Hospital Los Angeles, Clinical Research, Los Angeles, CA, Childrens Hospital Los Angeles, Division of Neonatal Medicine, Los Angeles, CA OBJECTIVE: To determine risk factors for neurodevelopmental function among children treated with laser for TTTS. STUDY DESIGN: Data were prospectively collected from surviving children treated between 2008-2010. Neurodevelopment at age 24 months ( 6 weeks) was assessed via the Battelle Developmental Inventory (BDI) total standardized score. Vital statistics and socio-demographic covariates were obtained. Clinical metrics were collected from a TTTS database. Power analysis determined that the a priori sample size required 100 children for adequate power (0.80). Multilevel linear regression models were used to evaluate risk factors for BDI at both childand pregnancy/family-levels. Non-significant predictors with p 0.10 were removed sequentially to arrive at the final model. RESULTS: 100 of 206 children (57 of 122 families) were evaluated. There were no differences between evaluated and non-evaluated enrollees in donor/recipient status and survival rates, fetal demise (IUFD), growth restriction (IUGR), Quintero stage, and gestational age (GA) of surgery or delivery. Total BDI score was within normal range (mean 101.3, SD 12.2), with only one child having a BDI of 70. Child risk factors for lower BDI included male sex ( 0.37, p 0.01), lower head circumference ( 0.28, p 0.01), and higher diastolic blood pressure ( 0.29, p 0.01). At the pregnancy/family level, lower maternal education ( 0.60, p 0.001), higher Quintero stage ( 0.36, p 0.01), lower GA at birth ( 30, p 0.01), married parents ( 0.25, p 0.05), and older corrected age ( 0.20, p 0.05) were associated with worse outcome. Donor/ recipient status, GA at surgery, IUGR, and IUFD were not risk factors for neurodevelopmental outcomes. CONCLUSION: This cohort of TTTS children showed developmental quotients in the normal range. The above-identified clinical and socio-economic characteristics may be useful to identify at-risk children that may benefit from early clinical and psychosocial interventions.