Spruijt Marjolijn S, Lopriore Enrico, Tan Ratna N G B, Slaghekke Femke, Klumper Frans J C M, Middeldorp Johanna M, Haak Monique C, Oepkes Dick, Rijken Monique, van Klink Jeanine M M
Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, J7-48, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Department of Obstetrics, Division of Fetal Therapy, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
J Clin Med. 2019 Aug 15;8(8):1226. doi: 10.3390/jcm8081226.
Despite many developments in its management, twin-to-twin transfusion syndrome (TTTS) remains an important risk factor for long-term neurodevelopmental impairment (NDI). Our objective was to compare the incidence of severe NDI in a recent cohort of TTTS survivors, treated with laser surgery from 2011 to 2014, with a previous cohort treated from 2008 to 2010. Neurological, cognitive, and motor development were assessed at two years of age. We determined risk factors associated with Bayley-III scores. Severe NDI occurred in 7/241 (3%) survivors in the new cohort compared to 10/169 (6%) in the previous cohort ( = 0.189). Disease-free survival (survival without severe impairment) did not significantly differ. Low birth weight and being small for gestational age (SGA) were independently associated with lower cognitive scores (both < 0.01). Severe cerebral injury was related to decreased motor scores (B = -14.10; 95% CI -3.16, -25.04; = 0.012). Children with severe NDI were born ≥32 weeks' gestation in 53% of cases and had no evidence of cerebral injury on cranial ultrasound in 59% of cases. Our results suggest that improvement in outcome of TTTS has reached a plateau. Low birth weight, SGA, and cerebral injury are risk factors for poor neurodevelopmental outcome. Neither gestational age above 32 weeks nor the absence of cerebral injury preclude severe NDI.
尽管在双胎输血综合征（TTTS）的治疗方面有诸多进展，但它仍是长期神经发育障碍（NDI）的一个重要风险因素。我们的目的是比较2011年至2014年接受激光手术治疗的TTTS幸存者近期队列与2008年至2010年治疗的先前队列中严重NDI的发生率。在两岁时评估神经、认知和运动发育情况。我们确定了与贝利婴幼儿发展量表第三版（Bayley-III）评分相关的风险因素。新队列中241名幸存者中有7名（3%）发生了严重NDI，而先前队列中169名幸存者中有10名（6%）发生了严重NDI（P = 0.189）。无病生存率（无严重损伤的生存）没有显著差异。低出生体重和小于胎龄（SGA）与较低的认知评分独立相关（均P < 0.01）。严重脑损伤与运动评分降低有关（B = -14.10；95%可信区间-3.16，-25.04；P = 0.012）。53%的严重NDI患儿出生时孕周≥32周，59%的患儿头颅超声检查无脑损伤证据。我们的结果表明，TTTS治疗效果的改善已达到平台期。低出生体重、SGA和脑损伤是神经发育不良结局的风险因素。孕周超过32周和无脑损伤均不能排除严重NDI的发生。
