Neurodevelopmental impairment at 3 years of age after fetoscopic laser surgery for twin-to-twin transfusion syndrome
Sachio Matsushima1, Katsusuke Ozawa1, Rika Sugibayashi1
1Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
Insights
Neurodevelopmental impairment (NDI) affected 8.5% of children after fetoscopic laser surgery (FLS) for twin-to-twin transfusion syndrome (TTTS). Prematurity was a key risk factor, and brain MRI showed potential for predicting cerebral palsy (CP).
Area of Science:
- Neonatal care
- Pediatric neurology
- Fetal surgery
Background:
- Data on neurodevelopmental outcomes for children surviving fetoscopic laser surgery (FLS) for twin-to-twin transfusion syndrome (TTTS) are limited.
- Evaluating long-term neurodevelopmental outcomes is crucial for understanding the impact of interventions like FLS.
Purpose of the Study:
- To assess neurodevelopmental outcomes at 3 years of age in children who survived FLS for TTTS.
- To identify risk factors associated with neurodevelopmental impairment (NDI) and the predictive value of brain MRI.
Main Methods:
- Retrospective study of 188 children from 110 twin pregnancies undergoing FLS for TTTS between 2003 and 2014.
- Standardized neurologic examinations using the Kyoto Scale 2001 at a corrected age of 3 years ± 6 months.
- Neurodevelopmental impairment (NDI) defined as cerebral palsy (CP), blindness, deafness, or developmental quotient (DQ) < 70; brain MRI performed at term-equivalent age.
Main Results:
- NDI was detected in 8.5% of children (16/188), with 3.2% (6/188) having cerebral palsy (CP).
- Earlier gestational age at delivery was significantly associated with a higher incidence of NDI (P < .001).
- Abnormal brain MRI findings were present in 56% (9/16) of children with NDI, including 100% (6/6) of those with CP.
Conclusions:
- The incidence of NDI at 3 years post-FLS for TTTS was 8.5%.
- Prematurity is a significant risk factor for NDI in this population.
- Brain MRI findings may help predict the development of CP in children following FLS for TTTS.
Background:
Data on neurodevelopmental outcomes of children surviving after fetoscopic laser surgery (FLS) for twin-to-twin transfusion syndrome (TTTS) are scarce.
Methods:
We retrospectively investigated children surviving after FLS for TTTS at 16 to 26 weeks' gestation between 2003 and 2014. Children were evaluated by standardized neurologic examinations using the Kyoto Scale 2001 at a corrected age of 3 years ± 6 months. Neurodevelopmental impairment (NDI) was defined as cerebral palsy (CP), bilateral blindness, bilateral deafness or a developmental quotient (DQ) < 70 points. Brain magnetic resonance imaging (MRI) was performed at term-equivalent age.
Results:
A total of 188 children from 110 twin pregnancies were evaluated. NDI was detected in 16/188 (8.5%) children, including six cases of CP (3.2%). No children had bilateral blindness or deafness. An earlier gestational age at delivery was associated with a higher incidence of NDI (P < .001). Abnormal brain MRI findings were detected in 9/16 (56%) of children with NDI, including 6/6 (100%) with CP.
Conclusion:
The incidence of NDI in children following FLS at 3 years old was 8.5%. Prematurity is a strong risk factor for NDI. Brain MRI may predict the development of CP.
