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Fetal brain‐sparing after laser surgery for twin‐twin transfusion syndrome appears associated with two‐year neurodevelopmental outcomes
Author(s) -
Chmait Ramen H.,
Chon Andrew H.,
Schrager Sheree M.,
Llanes Arlyn,
Hamilton Anita,
Vanderbilt Douglas L.
Publication year - 2016
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.4713
Subject(s) - medicine , laser surgery , twin twin transfusion syndrome , gestation , population , fetoscopy , fetus , laser coagulation , twin to twin transfusion syndrome , obstetrics , pediatrics , pregnancy , surgery , prenatal diagnosis , laser , physics , environmental health , visual acuity , biology , optics , genetics
Abstract Objective The cerebroplacental ratio (CPR) is a semi‐quantitative marker for fetal brain‐sparing. Our purpose was to measure the CPR at the time of treatment with selective laser photocoagulation of communicating vessels in gestations with twin‐twin transfusion syndrome (TTTS) to test its association with neurological outcomes at approximately 2 years. Methods One‐hundred children treated for TTTS with laser surgery underwent neurodevelopmental assessment at age 2 years (within 6 weeks) via the Battelle Developmental Inventory 2nd Edition (BDI‐2). The CPR was obtained 24 h before and after laser surgery. An abnormal CPR was categorically defined at <1.0. Multilevel linear regression was used to evaluate associations between CPR and neurodevelopment as assessed by the BDI‐2. Results Ninety‐nine children had data available for analysis: 55 (56%) had normal CPR prior to laser surgery, and 62 (63%) had normal CPR following surgery. Post‐laser CPR <1.0 was a risk factor for lower BDI‐2 scores at age 2 years [98.1 (SD 11.5) vs 103.4 (SD 12.3) vs β = −0.23, p = 0.01]; this relationship remained significant after controlling for pre‐surgical CPR and Quintero stage (adjusted β = −0.25, p = 0.01). Conclusions In this population, an abnormal CPR was associated with poorer 2‐year neurodevelopmental outcomes. © 2015 John Wiley & Sons, Ltd.