Neurodevelopmental Trajectories of Preterm Born Survivors of Twin-Twin Transfusion Syndrome: From Birth to 5 Years of Age

J Pediatr. 2022 Jan;240:51-57.e1. doi: 10.1016/j.jpeds.2021.09.002. Epub 2021 Sep 7.


Objective: To investigate the neurodevelopmental outcome at age 2 and 5 years in survivors of twin-twin transfusion syndrome (TTTS) treated with fetoscopic laser surgery and born premature and/or small for gestational age.

Study design: At 2 and 5 years of age, standardized neurologic, motor, and cognitive assessments were performed by a neonatologist, a pediatric physical therapist, and a psychologist. Behavior was assessed using a validated questionnaire completed by parents.

Results: Neurodevelopmental assessment at both time points was available for 73 survivors of TTTS. Mild to moderate neurodevelopmental impairment (NDI) was detected in 34% of survivors (25 of 73) at 5 years, compared with 25% (18 of 73) at 2 years (P = .178). Severe NDI was observed in 12% (9 of 73) at 5 years and in 3% (2 of 73) at 2 years (P = .035). Mean cognitive score was lower at the 5-year follow-up (90.7 ± 12.3 vs 95.6 ± 13.1 at 2 years; P = .001), and more children were diagnosed with mild cognitive impairment at 5 years (29% vs 11% at 2 years; P = .007). When comparing individual outcomes at both time points, 35% (25 of 71) moved from a normal outcome or mild to moderate impairment at 2 years toward more severe impairment at 5 years.

Conclusions: A high rate of mild to moderate cognitive impairment and severe NDI at age 5 years was not identified at age 2 years. Our data highlight the importance of longitudinal follow-up of survivors of TTTS beyond age 2 years and emphasize the precautions that should be taken when diagnosing an absence of impairment before school age.

Keywords: behavior; cerebral palsy; fetoscopic laser surgery; long-term follow-up; neurodevelopmental impairment; twin-twin transfusion syndrome.

MeSH terms

  • Child, Preschool
  • Female
  • Fetofetal Transfusion / surgery*
  • Fetoscopy
  • Follow-Up Studies
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature*
  • Infant, Small for Gestational Age
  • Laser Coagulation
  • Male
  • Neurodevelopmental Disorders / diagnosis
  • Neurodevelopmental Disorders / epidemiology*
  • Pregnancy
  • Survivors*