Long-Term Neurodevelopmental Outcome in Twin-to-Twin Transfusion Syndrome: Is there still Room for Improvement?
Abstract
:1. Introduction
2. Experimental Section
Statistical Analysis
3. Results
3.1. Perinatal Characteristics of Included TTTS Pregnancies
3.2. Long-Term Follow-Up
Neurodevelopmental Outcome
3.3. Risk Factors
4. Discussion
5. Conclusions
Author Contributions
Acknowledgments
Conflicts of Interest
References
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Previous Cohort: 2008–2010 N = 176 | New Cohort: 2011–2014 N = 258 | p | |
---|---|---|---|
Donor | 90 (51) | 130 (50) | 0.685 |
Gestational age at laser (weeks) | 20.3 ± 3.4 | 20.0 ± 3.4 | 0.663 |
TTTS stage—median (range) I II III IV | 3 (1–4) 24 (14) 48 (27) 102 (58) 2 (1) | 3 (1–4) 35 (14) 89 (34) 127 (49) 7 (3) | 0.515 |
Post-laser TAPS or recurrent TTTS | 20/176 (11) | 25/258 (10) | 0.523 |
Fetal demise of co-twin | 18 (10) | 29 (11) | 0.771 |
Gestational age at birth (weeks) >37 weeks 33–36 weeks 26–32 weeks 24–25 weeks | 32.4 ± 3.4 16 (9) 74 (42) 86 (49) 0 | 32.9 ± 3.1 21 (8) 116 (45) 112 (43) 9 (3) | 0.516 |
Birth weight (grams) | 1771 ± 596 | 1826 ± 610 | 0.717 |
Small for gestational age a | 16 (9) | 22 (9) | 0.835 |
Severe cerebral injury b | 9 (5) | 11 (4) | 0.681 |
Female | 95 (54) | 127 (49) | 0.353 |
Previous Cohort: 2008–2010 N = 176 | New Cohort: 2011–2014 N = 258 | p | |
---|---|---|---|
Severe NDI a | 10/169 (6) | 7/241 (3) | 0.189 |
Disease-free survival b | 162/215 (75%) | 241/340 (71%) | 0.263 |
Cerebral Palsy Cerebral Palsy grade I Cerebral Palsy grade II–V | 5/176 (3) 1 (1) 4 (2) | 4/258 (2) 3 (1) 1 (0.4) | 0.356 |
Cognitive composite score | 101 ± 14 | 99 ± 13 | 0.220 |
Cognitive composite score < −2SD | 5/169 (3) | 1/240 (0.4) | 0.097 |
Motor composite score | 102 ± 15 | 97 ± 14 | 0.003 |
Motor composite score < −2SD | 5/164 (3) | 6/234 (3) | 0.723 |
Risk Factor | Cognitive Composite Score Univariate | Motor Composite Score Univariate | ||
---|---|---|---|---|
B (95% CI) | p | B (95% CI) | p | |
Donor | −1.10 (−2.46–0.27) | 0.115 | 1.29 (−0.67–3.25) | 0.196 |
TTTS stage | 0.10 (−2.108–2.30) | 0.928 | 0.51 (−1.64–2.66) | 0.642 |
GA at laser | −0.27 (−0.77–0.23) | 0.291 | −0.13 (−0.66–0.40) | 0.634 |
Incomplete laser | −2.96 (−8.20–2.28) | 0.268 | −4.65 (−9.69–0.39) | 0.071 |
Fetal demise co-twin | 3.17 (−1.02–7.36) | 0.138 | 1.89 (−2.71–6.48) | 0.421 |
GA at birth | 0.49 (−0.01–0.99) | 0.056 | −0.10 (−0.64–0.43) | 0.707 |
Birth weight a | 0.41 (0.18–0.64) | 0.000 | −0.79 (−0.32–0.16) | 0.521 |
Growth restriction b | −5.67 (−9.35 to −1.99) | 0.003 | −0.47 (−4.52–3.58) | 0.822 |
Severe cerebral injury | −2.11 (−8.96–4.73) | 0.545 | −14.10 (−25.04 to −3.16) | 0.012 |
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Spruijt, M.S.; Lopriore, E.; Tan, R.N.G.B.; Slaghekke, F.; Klumper, F.J.C.M.; Middeldorp, J.M.; Haak, M.C.; Oepkes, D.; Rijken, M.; van Klink, J.M.M. Long-Term Neurodevelopmental Outcome in Twin-to-Twin Transfusion Syndrome: Is there still Room for Improvement? J. Clin. Med. 2019, 8, 1226. https://doi.org/10.3390/jcm8081226
Spruijt MS, Lopriore E, Tan RNGB, Slaghekke F, Klumper FJCM, Middeldorp JM, Haak MC, Oepkes D, Rijken M, van Klink JMM. Long-Term Neurodevelopmental Outcome in Twin-to-Twin Transfusion Syndrome: Is there still Room for Improvement? Journal of Clinical Medicine. 2019; 8(8):1226. https://doi.org/10.3390/jcm8081226
Chicago/Turabian StyleSpruijt, Marjolijn S., Enrico Lopriore, Ratna N.G.B. Tan, Femke Slaghekke, Frans J.C.M. Klumper, Johanna M. Middeldorp, Monique C. Haak, Dick Oepkes, Monique Rijken, and Jeanine M.M. van Klink. 2019. "Long-Term Neurodevelopmental Outcome in Twin-to-Twin Transfusion Syndrome: Is there still Room for Improvement?" Journal of Clinical Medicine 8, no. 8: 1226. https://doi.org/10.3390/jcm8081226