Long‐term neurological outcome of survivors of twin twin transfusion syndrome (TTTS)

Abstract

Aim: The aim of this study was to examine the long‐term neurological outcome of survivors of TTTS.Methods: Survivors of TTTS were followed up in the multidisciplinary Growth and Development Unit in the Mater Children's Hospital. A detailed neurological examination and a neurosensory motor developmental assessment was performed. Cerebral palsy (CP) was diagnosed on the basis of this examination according to standard criteria. A Griffith's developmental assessment was performed by a psychologist. A general quotient (GQ) more than two standard deviations below the mean (GQ < 76) represented global developmental delay (GDD).Results: There were 39 cases of TTTS delivered at the Mater Mother's Hospital, from January 1994 until June 2000. There were 48 surviving infants (62%), 17 stillbirths (22%), and 13 NND (17%). The mean gestation of delivery was 28.5 weeks (range 19–36). Fifty‐nine percent of cases were treated with amnioreduction whilst the others were delivered prior to treatment. Of the 48 survivors, detailed neurological assessment from 1 to 4 years was available for 35 (73%). An additional four twins were known to have normal long‐term outcomes but formal neuro‐developmental assessment had not been performed and the others had been lost to follow up. Of those with complete assessment, 29 (83%) were normal. There were three (8.6%) cases with CP and three (8.6%) with GDD. Of the three cases with CP, one had a co‐twin that had a FDIU, one had a co‐twin with GDD and the other had a normal co‐twin. The other two cases of GDD had normal co‐twins.Conclusion: Survivors of TTTS have a significant risk of major neuro‐developmental impairment such as cerebral palsy and global developmental delay. Further research is required to determine what factors contribute to this risk and to develop treatments to minimise the incidence and severity of these handicaps.