RESUMO
OBJECTIVE: To investigate the neurodevelopmental outcome at age 2 and 5 years in survivors of twin-twin transfusion syndrome (TTTS) treated with fetoscopic laser surgery and born premature and/or small for gestational age. STUDY DESIGN: At 2 and 5 years 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. RESULTS: 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 5 years, compared with 25% (18 of 73) at 2 years (P = .178). Severe NDI was observed in 12% (9 of 73) at 5 years and in 3% (2 of 73) at 2 years (P = .035). Mean cognitive score was lower at the 5-year follow-up (90.7 ± 12.3 vs 95.6 ± 13.1 at 2 years; P = .001), and more children were diagnosed with mild cognitive impairment at 5 years (29% vs 11% at 2 years; 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 2 years toward more severe impairment at 5 years. CONCLUSIONS: A high rate of mild to moderate cognitive impairment and severe NDI at age 5 years was not identified at age 2 years. Our data highlight the importance of longitudinal follow-up of survivors of TTTS beyond age 2 years and emphasize the precautions that should be taken when diagnosing an absence of impairment before school age.
Assuntos
Transfusão Feto-Fetal/cirurgia , Recém-Nascido Prematuro , Transtornos do Neurodesenvolvimento/epidemiologia , Sobreviventes , Pré-Escolar , Feminino , Fetoscopia , Seguimentos , Humanos , Lactente , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Fotocoagulação a Laser , Masculino , Transtornos do Neurodesenvolvimento/diagnóstico , GravidezRESUMO
OBJECTIVE: To determine neonatal mortality and morbidity rates in monochorionic twins with chronic twin-to-twin transfusion syndrome (TTTS) treated with fetoscopic laser occlusion of vascular anastomoses. STUDY DESIGN: In a prospective study of monochorionic twins delivered at our center between June 2002 and December 2004, neonatal outcome was assessed in 40 monochorionic twin pairs with TTTS treated with laser compared with 46 monochorionic twin pairs without TTTS. RESULTS: The neonatal mortality rate in the TTTS and no-TTTS group was 8% (6/76) and 3% (3/90), respectively. The rate of severe cerebral lesions on ultrasound scanning in the TTTS and no-TTTS group was 14% (10/72) and 6% (5/82), respectively. The incidence of adverse neonatal outcome (neonatal death, major neonatal morbidity, or severe cerebral lesions) in the TTTS and no-TTTS group was, respectively, 26% (20/76) and 13% (12/90) (RR = 1.97, 95% CI = 1.03 to 3.77). CONCLUSIONS: Although perinatal outcome in TTTS has improved after laser therapy, neonatal mortality and morbidity rates remain high. Relative risk for adverse neonatal outcome is increased 2-fold in TTTS treated with laser relative to monochorionic twins without TTTS.