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Long-Term Neurodevelopmental Outcome in Twin-to-Twin Transfusion Syndrome: Is there still Room for Improvement?

Despite many developments in its management, twin-to-twin transfusion syndrome (TTTS) remains an important risk factor for long-term neurodevelopmental impairment (NDI). Our objective was to compare the incidence of severe NDI in a recent cohort of TTTS survivors, treated with laser surgery from 201...

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Autores principales: Spruijt, Marjolijn S., Lopriore, Enrico, Tan, Ratna N.G.B., Slaghekke, Femke, Klumper, Frans J.C.M., Middeldorp, Johanna M., Haak, Monique C., Oepkes, Dick, Rijken, Monique, van Klink, Jeanine M.M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723379/
https://www.ncbi.nlm.nih.gov/pubmed/31443258
http://dx.doi.org/10.3390/jcm8081226
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author Spruijt, Marjolijn S.
Lopriore, Enrico
Tan, Ratna N.G.B.
Slaghekke, Femke
Klumper, Frans J.C.M.
Middeldorp, Johanna M.
Haak, Monique C.
Oepkes, Dick
Rijken, Monique
van Klink, Jeanine M.M.
author_facet Spruijt, Marjolijn S.
Lopriore, Enrico
Tan, Ratna N.G.B.
Slaghekke, Femke
Klumper, Frans J.C.M.
Middeldorp, Johanna M.
Haak, Monique C.
Oepkes, Dick
Rijken, Monique
van Klink, Jeanine M.M.
author_sort Spruijt, Marjolijn S.
collection PubMed
description Despite many developments in its management, twin-to-twin transfusion syndrome (TTTS) remains an important risk factor for long-term neurodevelopmental impairment (NDI). Our objective was to compare the incidence of severe NDI in a recent cohort of TTTS survivors, treated with laser surgery from 2011 to 2014, with a previous cohort treated from 2008 to 2010. Neurological, cognitive, and motor development were assessed at two years of age. We determined risk factors associated with Bayley-III scores. Severe NDI occurred in 7/241 (3%) survivors in the new cohort compared to 10/169 (6%) in the previous cohort (p = 0.189). Disease-free survival (survival without severe impairment) did not significantly differ. Low birth weight and being small for gestational age (SGA) were independently associated with lower cognitive scores (both p < 0.01). Severe cerebral injury was related to decreased motor scores (B = −14.10; 95% CI −3.16, −25.04; p = 0.012). Children with severe NDI were born ≥32 weeks’ gestation in 53% of cases and had no evidence of cerebral injury on cranial ultrasound in 59% of cases. Our results suggest that improvement in outcome of TTTS has reached a plateau. Low birth weight, SGA, and cerebral injury are risk factors for poor neurodevelopmental outcome. Neither gestational age above 32 weeks nor the absence of cerebral injury preclude severe NDI.
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spelling pubmed-67233792019-09-10 Long-Term Neurodevelopmental Outcome in Twin-to-Twin Transfusion Syndrome: Is there still Room for Improvement? Spruijt, Marjolijn S. Lopriore, Enrico Tan, Ratna N.G.B. Slaghekke, Femke Klumper, Frans J.C.M. Middeldorp, Johanna M. Haak, Monique C. Oepkes, Dick Rijken, Monique van Klink, Jeanine M.M. J Clin Med Article Despite many developments in its management, twin-to-twin transfusion syndrome (TTTS) remains an important risk factor for long-term neurodevelopmental impairment (NDI). Our objective was to compare the incidence of severe NDI in a recent cohort of TTTS survivors, treated with laser surgery from 2011 to 2014, with a previous cohort treated from 2008 to 2010. Neurological, cognitive, and motor development were assessed at two years of age. We determined risk factors associated with Bayley-III scores. Severe NDI occurred in 7/241 (3%) survivors in the new cohort compared to 10/169 (6%) in the previous cohort (p = 0.189). Disease-free survival (survival without severe impairment) did not significantly differ. Low birth weight and being small for gestational age (SGA) were independently associated with lower cognitive scores (both p < 0.01). Severe cerebral injury was related to decreased motor scores (B = −14.10; 95% CI −3.16, −25.04; p = 0.012). Children with severe NDI were born ≥32 weeks’ gestation in 53% of cases and had no evidence of cerebral injury on cranial ultrasound in 59% of cases. Our results suggest that improvement in outcome of TTTS has reached a plateau. Low birth weight, SGA, and cerebral injury are risk factors for poor neurodevelopmental outcome. Neither gestational age above 32 weeks nor the absence of cerebral injury preclude severe NDI. MDPI 2019-08-15 /pmc/articles/PMC6723379/ /pubmed/31443258 http://dx.doi.org/10.3390/jcm8081226 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Spruijt, Marjolijn S.
Lopriore, Enrico
Tan, Ratna N.G.B.
Slaghekke, Femke
Klumper, Frans J.C.M.
Middeldorp, Johanna M.
Haak, Monique C.
Oepkes, Dick
Rijken, Monique
van Klink, Jeanine M.M.
Long-Term Neurodevelopmental Outcome in Twin-to-Twin Transfusion Syndrome: Is there still Room for Improvement?
title Long-Term Neurodevelopmental Outcome in Twin-to-Twin Transfusion Syndrome: Is there still Room for Improvement?
title_full Long-Term Neurodevelopmental Outcome in Twin-to-Twin Transfusion Syndrome: Is there still Room for Improvement?
title_fullStr Long-Term Neurodevelopmental Outcome in Twin-to-Twin Transfusion Syndrome: Is there still Room for Improvement?
title_full_unstemmed Long-Term Neurodevelopmental Outcome in Twin-to-Twin Transfusion Syndrome: Is there still Room for Improvement?
title_short Long-Term Neurodevelopmental Outcome in Twin-to-Twin Transfusion Syndrome: Is there still Room for Improvement?
title_sort long-term neurodevelopmental outcome in twin-to-twin transfusion syndrome: is there still room for improvement?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723379/
https://www.ncbi.nlm.nih.gov/pubmed/31443258
http://dx.doi.org/10.3390/jcm8081226
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