Neonatal cerebral lesions predict 2-year neurodevelopmental impairment in children treated with laser surgery for twin-twin transfusion syndrome

J Matern Fetal Neonatal Med. 2019 Jan;32(1):80-84. doi: 10.1080/14767058.2017.1371694. Epub 2017 Sep 6.


Objective: The objective of this study is to assess whether postnatally detected cerebral abnormalities are predictive of neurodevelopmental impairment (NDI) in survivors of twin-twin transfusion syndrome (TTTS) that underwent laser surgery.

Materials and methods: Ninety-nine children treated for TTTS had neurodevelopmental assessment at age 2-years (±6 weeks). 'High-risk survivors' had cerebral imaging in the neonatal period. 'High-risk survivors' were defined as (1) delivered at <32 weeks; or (2) cerebral imaging clinically indicated. NDI was a composite outcome of: Battelle Developmental Inventory 2nd edition (BDI-2) score <70, cerebral palsy, blindness, and/or deafness. Multilevel logistic regression with robust standard errors was used to evaluate associations between cerebral lesions and NDI.

Results: Fifty-six children were 'high-risk survivors' and had neonatal cerebral imaging. Ten twins (18%) had at least one cerebral lesion, including grade 1-2 intraventricular hemorrhage (8), cystic periventricular leukomalacia (2), ventriculomegaly (1), and bilateral subependymal cyst (1). The risk of NDI in the 'high-risk survivors' was 7% (4/56) compared with 0% (0/43) in the remaining group. Among 'high-risk survivors', cerebral lesions were a significant risk factor for NDI (OR = 19.28, p < .001).

Conclusions: Among 'high-risk survivors' of TTTS treated with laser surgery, cerebral lesions identified on neonatal imaging were associated with NDI at 2-years.

Keywords: Cerebral lesions; monochorionic; neurodevelopmental impairment; twin–twin transfusion syndrome.

MeSH terms

  • Cerebrum / diagnostic imaging*
  • Child, Preschool
  • Female
  • Fetal Therapies
  • Fetofetal Transfusion / complications*
  • Fetofetal Transfusion / diagnostic imaging
  • Fetofetal Transfusion / surgery
  • Follow-Up Studies
  • Humans
  • Infant, Newborn
  • Laser Therapy
  • Male
  • Neurodevelopmental Disorders / diagnostic imaging
  • Neurodevelopmental Disorders / etiology*
  • Neuroimaging
  • Pregnancy