Evaluation of long‐term neurodevelopment in twin‐twin transfusion syndrome after laser therapy

Objective The primary objective of our study was to evaluate the long-term neurodevelopment outcome after laser surgery for twin-twin transfusion syndrome (TTTS). The secondary objective was to identify perinatal prognostic factors associated with neurodevelopmental impairment. Method This was a single-center cohort prospective study carried out in pregnancies complicated by TTTS and treated by laser. Neurodevleopmental assesment included the administration of Ages and Stages Questionnaires® (ASQ), for the infants between two and five years of age. Results A total of 187 patients underwent a laser for TTTS between 2004 and 2013. Significant brain lesions were detected in 8 (2.9%) cases by ultrasound and/or MRI including intraventricular hemorrhage, periventricular leukomalacia and porencephaly. Questionnaires were administered to 126 children (50.4%) at 24 months or older at the moment of testing. There were 13.5% of those infants who had an abnormal ASQ (established as 1 area or more scoring < 2SD) at 3.6 years +/- 1.3 follow-up. There was a higher rate of abnormal ASQ among the infants with a birth weight below the fifth percentile (p = 0.036). Conclusion TTTS is associated with a risk of abnormal neurological development, even in case of laser surgery. Further studies are necessary to identify the risk factors for neurological impairment.