Long-Term Neurodevelopmental Outcome of 167 Children After Intrauterine Laser Treatment for Severe Twin???Twin Transfusion Syndrome

Abstract

Between 10% and 15% of monochorionic diamniotic twin pregnancies are complicated by severe twin–twin transfusion syndrome (TTTS), a cause of perinatal morbidity and death. The syndrome results from an unbalanced transfusion of blood across placental vascular anastomoses from one twin, the donor, to the other, the recipient. This prospective study was done to ascertain long-term neurodevelopmental outcomes in children born after intrauterine laser coagulation. The subjects were 167 infants from 127 pregnancies who survived severe TTTS in the years 1997 through 1999. At a mean age of 38 months, the children were assessed by a detailed physical and neurologic examination, Griffiths Developmental Test Scales and Snijders-Oomen NonVerbal-Intelligence Test (SON). Normal neurological findings were recorded in 87% of the children, and another 7% had minor abnormalities. Only 10 children, 6% of the total, had major neurologic abnormalities. Outcomes were comparable in former donors and recipients, and in infants born as twins and those born as singletons. The Griffiths test identified developmental delay in 25% of the 40 children tested. Seven of these 10 infants had severe neurologic abnormalities and the other 3 had minor abnormalities. Only 2 of 112 infants tested by the SON had subnormal results. All children who were neurologically normal had normal test results. Significantly more children with major or minor neurologic abnormalities were born before 32 weeks gestation compared with those who were neurologically normal. However, neither birth weight nor gestational age at the time of treatment was related to the outcome. These results, in children with severe TTTS who underwent fetoscopic laser coagulation, are more favorable than those reported from other studies. At present, this would appear to be the best available treatment for severe TTTS.