TY - JOUR
T1 - Developmental outcomes for survivors of placental laser photocoagulation for the management of twin-to-twin transfusion syndrome
AU - Guzys, Angela
AU - Reid, Susan M.
AU - Bolch, Christie
AU - Reddihough, Dinah S.
AU - Teoh, Mark
AU - Palma-Dias, Ricardo
AU - Fung, Alison
AU - Cole, Stephen
AU - Hodges, Ryan
AU - Fahey, Michael
AU - Walker, Susan P.
N1 - Funding Information:
We were able to associate the risk of long-term neurodevelopmental impairment in children that survived placental laser photocoagulation with maturity at delivery and neonatal wellbeing. Early birth gestation and low birthweight were similarly recognised as risk factors in studies included in two systematic reviews, the Knijnenburg et al.review [], and a 2021 review by Hessami et al. []. Higher Quintero TTTS stage at laser was determined to increase risk in 4 of 5 studies included in the Knijnenburg et al.review but was not significantly associated with neurodevelopmental impairment in the Hessami et al.review. We were unable to include Quintero stage in the present study, but, in the first 5 years of the Victorian service, there was no significant difference in perinatal survival by Quintero stage (77% for stages 2–3 versus 66% for stage 4) []. We found little evidence to support a difference in long-term impairment between donor and recipient twins. This finding was supported by data from three systematic reviews [, , ]. There were mixed findings in the Knujnenburg et al.systematic review with respect to maternal level of education []. In our study, there was strong evidence in support of a higher frequency of neurodevelopmental impairment in children of mothers who had not completed a bachelor’s degree or higher.
Publisher Copyright:
© 2023, BioMed Central Ltd., part of Springer Nature.
PY - 2023/12
Y1 - 2023/12
N2 - Background: Fetoscopic laser coagulation of placental anastomoses reverses the pathological process in twin-to-twin transfusion syndrome, thereby increasing survival, but there are a paucity of studies addressing long-term neurodevelopmental outcome of survivors. This study aimed to ascertain the presence of neurodevelopmental disabilities in child survivors of monochorionic pregnancies managed by placental laser photocoagulation in the Australian state of Victoria. Methods: All pregnancies undergoing placental laser photocoagulation with the Victorian Fetal Therapy Service between 2006–2017 were included. Information on each surviving child, including demographics, perinatal course, and developmental progress was collected from parents, and consent was sought to complete the Child Behaviour Checklist. Interviewers evaluated whether this information was consistent with a diagnosis of any of 14 neurodevelopmental conditions. A three-tiered outcome measure was allocated for each child: (1) unimpaired or developmentally normal, (2) mild or moderate neurological impairment, or (3) severe neurological impairment. Clinical predictors for adverse outcome were identified. Results: Of 116 pregnancies (113 twin, 3 triplet), 96 (83%) resulted in 1 + surviving fetuses. 57/113 (50%) twin pregnancies resulted in 2 survivors, 36 (32%) in 1 survivor, and 20 (18%) in no survivors. Of the 235 fetuses, 154 (65.5%) survived to follow-up. Survival increased from 59% in 2006–2008 to 73% in 2015–2017. 90/154 (58%) survivors were followed up at a mean age of 7.5 [SD 3.0] years. Based on parental interview and Child Behaviour Checklist data, 28/90 (31%) participants were assessed as having neurodevelopmental impairment, 27 of mild-moderate severity and 1 severe. Speech/language disorders, attention deficit (hyperactivity) disorders, and fine motor impairment were most common. Neonatal length of stay conferred the highest risk of impairment. Conclusion: Substantial variation exists between fetal therapy services in the type and length of neonatal follow-up following fetoscopic laser coagulation, contributing to a lack of data on long-term outcomes. The findings from this study support increasingly urgent calls to undertake systematic and sustained follow-up of fetoscopic laser coagulation survivors until school age. Information from this study may assist parents in their decision-making when offered fetal surgery. Importantly, it highlights a group for targeted surveillance and early intervention.
AB - Background: Fetoscopic laser coagulation of placental anastomoses reverses the pathological process in twin-to-twin transfusion syndrome, thereby increasing survival, but there are a paucity of studies addressing long-term neurodevelopmental outcome of survivors. This study aimed to ascertain the presence of neurodevelopmental disabilities in child survivors of monochorionic pregnancies managed by placental laser photocoagulation in the Australian state of Victoria. Methods: All pregnancies undergoing placental laser photocoagulation with the Victorian Fetal Therapy Service between 2006–2017 were included. Information on each surviving child, including demographics, perinatal course, and developmental progress was collected from parents, and consent was sought to complete the Child Behaviour Checklist. Interviewers evaluated whether this information was consistent with a diagnosis of any of 14 neurodevelopmental conditions. A three-tiered outcome measure was allocated for each child: (1) unimpaired or developmentally normal, (2) mild or moderate neurological impairment, or (3) severe neurological impairment. Clinical predictors for adverse outcome were identified. Results: Of 116 pregnancies (113 twin, 3 triplet), 96 (83%) resulted in 1 + surviving fetuses. 57/113 (50%) twin pregnancies resulted in 2 survivors, 36 (32%) in 1 survivor, and 20 (18%) in no survivors. Of the 235 fetuses, 154 (65.5%) survived to follow-up. Survival increased from 59% in 2006–2008 to 73% in 2015–2017. 90/154 (58%) survivors were followed up at a mean age of 7.5 [SD 3.0] years. Based on parental interview and Child Behaviour Checklist data, 28/90 (31%) participants were assessed as having neurodevelopmental impairment, 27 of mild-moderate severity and 1 severe. Speech/language disorders, attention deficit (hyperactivity) disorders, and fine motor impairment were most common. Neonatal length of stay conferred the highest risk of impairment. Conclusion: Substantial variation exists between fetal therapy services in the type and length of neonatal follow-up following fetoscopic laser coagulation, contributing to a lack of data on long-term outcomes. The findings from this study support increasingly urgent calls to undertake systematic and sustained follow-up of fetoscopic laser coagulation survivors until school age. Information from this study may assist parents in their decision-making when offered fetal surgery. Importantly, it highlights a group for targeted surveillance and early intervention.
KW - Fetal therapies
KW - Fetoscopy
KW - Laser therapy
KW - Twin-twin transfusion
KW - Twins
UR - http://www.scopus.com/inward/record.url?scp=85173556799&partnerID=8YFLogxK
U2 - 10.1186/s12884-023-05997-5
DO - 10.1186/s12884-023-05997-5
M3 - Article
C2 - 37770827
AN - SCOPUS:85173556799
SN - 1471-2393
VL - 23
JO - BMC Pregnancy and Childbirth
JF - BMC Pregnancy and Childbirth
IS - 1
M1 - 699
ER -