Neurodevelopmental Trajectories of Preterm Born Survivors of Twin–Twin Transfusion Syndrome: From Birth to 5 Years of Age

Abstract

To investigate the neurodevelopmental outcome at age 2 and 5years in survivors of twin-twin transfusion syndrome (TTTS) treated with fetoscopic laser surgery and born premature and/or small for gestational age. At 2 and 5years of age, standardized neurologic, motor, and cognitive assessments were performed by a neonatologist, a pediatric physical therapist, and a psychologist. Behavior was assessed using a validated questionnaire completed by parents. Neurodevelopmental assessment at both time points was available for 73 survivors of TTTS. Mild to moderate neurodevelopmental impairment (NDI) was detected in 34% of survivors (25 of 73) at 5years, compared with 25% (18 of 73) at 2years (P=.178). Severe NDI was observed in 12% (9 of 73) at 5years and in 3% (2 of 73) at 2years (P=.035). Mean cognitive score was lower at the 5-year follow-up (90.7±12.3 vs 95.6±13.1 at 2years; P=.001), and more children were diagnosed with mild cognitive impairment at 5years (29% vs 11% at 2years; P=.007). When comparing individual outcomes at both time points, 35% (25 of 71) moved from a normal outcome or mild to moderate impairment at 2years toward more severe impairment at 5years. A high rate of mild to moderate cognitive impairment and severe NDI at age 5years was not identified at age 2years. Our data highlight the importance of longitudinal follow-up of survivors of TTTS beyond age 2years and emphasize the precautions that should be taken when diagnosing an absence of impairment before school age.