Neurodevelopmental outcome at 2 years in children born preterm treated by amnioreduction or fetoscopic laser surgery for twin-to-twin transfusion syndrome: comparison with dichorionic twins.

Abstract

We sought to assess long-term neurodevelopment of children born prematurely treated for twin-to-twin transfusion syndrome and dichorionic (DC) twins. In all, 21 and 88 children treated with amnioreduction (AR) and fetoscopic laser surgery (FLS), respectively, and 222 DC twins matched for gestational age at delivery were assessed with Ages and Stages Questionnaire and standardized examination at 2 years of age. Normal development was noted in 81% in the AR group, 88.6% in the FLS group, and 93.1% in the DC twins. Minor and major neurologic impairment was found in 9.5% and 9.5% following AR, in 6.8% and 4.6% of FLS children, and in 3.4% and 3.4% in DC twins, respectively. Ages and Stages Questionnaire assessment was similar in FLS and DC children but scores were lower (P = .01) and domains were more often abnormal (60% vs 27%; P = .005) following AR. Neurodevelopmental outcome is similar in twin-to-twin transfusion syndrome survivors treated by FLS and in DC control subjects; but survivors treated with AR have an increased risk of neurodevelopmental delay at 2 years of age.