390: Long-term neurodevelopmental outcome in twin-to-twin transfusion syndrome (TTTS) in the eurofoetus trial

Abstract

ObjectiveEndoscopic laser coagulation of anastomoses is a more effective first-line treatment than serial amnioreduction for severe twin-to-twin transfusion syndrome with a higher survival rate and less neurological complications at 6 months of age.To investigate neuro-developmental outcome of survivors at 6 months, at the age of 5-6 years in the Eurofoetus RCT comparing endoscopic laser surgery (L) and serial amnioreduction (A) in TTTS.Study DesignAll survivors beyond 6 months were followed-up and evaluated by standardized neurological examination (Amiel-Tison and Gosselin) and by Ages and Stages questionnaires (ASQ) at 5 years of age. Primary outcome was the incidence of both severe and minor neurological abnormalities. In addition children were subjected to cognitive evaluation using Wechsler Intelligence Scale for Children (WISC-IV) at the age of 6.ResultsTwenty-four families were lost to follow-up. 148 children were born alive from 98 pregnancies (including 58 twin pairs) treated by either serial amnioreduction (n=44) or laser coagulation (n=53). 111 children (R:recipient, D:Donnors) survived beyond 6 months, and were examined including 42A (22D+20R) and 69 L (35D-34R).At 5 years all studied parameters were independent from intrauterine treatment. The incidence of major and minor neurological abnormalities was 17/111 (15.3%) (19% in A and 13% in L), and was higher in R vs D children (2D vs 6R in A, and 3D vs 6R in L) (p<0.003) in both treatment groups. Apgar score at 1 min, and arterial Ph were still predictive of low ASQ scores (p<0.001) at 24 and 48 months. However ASQ scores at 60 months and WISC score were independent from perinatal-related factors.ConclusionAmong survivors at 6 months, the risk of developing long-term minor and major neurological impairment is dependent upon the status of ex-donor or ex-recipient as well as upon perinatal factors but not fetal treatment. ObjectiveEndoscopic laser coagulation of anastomoses is a more effective first-line treatment than serial amnioreduction for severe twin-to-twin transfusion syndrome with a higher survival rate and less neurological complications at 6 months of age.To investigate neuro-developmental outcome of survivors at 6 months, at the age of 5-6 years in the Eurofoetus RCT comparing endoscopic laser surgery (L) and serial amnioreduction (A) in TTTS. Endoscopic laser coagulation of anastomoses is a more effective first-line treatment than serial amnioreduction for severe twin-to-twin transfusion syndrome with a higher survival rate and less neurological complications at 6 months of age. To investigate neuro-developmental outcome of survivors at 6 months, at the age of 5-6 years in the Eurofoetus RCT comparing endoscopic laser surgery (L) and serial amnioreduction (A) in TTTS. Study DesignAll survivors beyond 6 months were followed-up and evaluated by standardized neurological examination (Amiel-Tison and Gosselin) and by Ages and Stages questionnaires (ASQ) at 5 years of age. Primary outcome was the incidence of both severe and minor neurological abnormalities. In addition children were subjected to cognitive evaluation using Wechsler Intelligence Scale for Children (WISC-IV) at the age of 6. All survivors beyond 6 months were followed-up and evaluated by standardized neurological examination (Amiel-Tison and Gosselin) and by Ages and Stages questionnaires (ASQ) at 5 years of age. Primary outcome was the incidence of both severe and minor neurological abnormalities. In addition children were subjected to cognitive evaluation using Wechsler Intelligence Scale for Children (WISC-IV) at the age of 6. ResultsTwenty-four families were lost to follow-up. 148 children were born alive from 98 pregnancies (including 58 twin pairs) treated by either serial amnioreduction (n=44) or laser coagulation (n=53). 111 children (R:recipient, D:Donnors) survived beyond 6 months, and were examined including 42A (22D+20R) and 69 L (35D-34R).At 5 years all studied parameters were independent from intrauterine treatment. The incidence of major and minor neurological abnormalities was 17/111 (15.3%) (19% in A and 13% in L), and was higher in R vs D children (2D vs 6R in A, and 3D vs 6R in L) (p<0.003) in both treatment groups. Apgar score at 1 min, and arterial Ph were still predictive of low ASQ scores (p<0.001) at 24 and 48 months. However ASQ scores at 60 months and WISC score were independent from perinatal-related factors. Twenty-four families were lost to follow-up. 148 children were born alive from 98 pregnancies (including 58 twin pairs) treated by either serial amnioreduction (n=44) or laser coagulation (n=53). 111 children (R:recipient, D:Donnors) survived beyond 6 months, and were examined including 42A (22D+20R) and 69 L (35D-34R). At 5 years all studied parameters were independent from intrauterine treatment. The incidence of major and minor neurological abnormalities was 17/111 (15.3%) (19% in A and 13% in L), and was higher in R vs D children (2D vs 6R in A, and 3D vs 6R in L) (p<0.003) in both treatment groups. Apgar score at 1 min, and arterial Ph were still predictive of low ASQ scores (p<0.001) at 24 and 48 months. However ASQ scores at 60 months and WISC score were independent from perinatal-related factors. ConclusionAmong survivors at 6 months, the risk of developing long-term minor and major neurological impairment is dependent upon the status of ex-donor or ex-recipient as well as upon perinatal factors but not fetal treatment. Among survivors at 6 months, the risk of developing long-term minor and major neurological impairment is dependent upon the status of ex-donor or ex-recipient as well as upon perinatal factors but not fetal treatment.