胎儿镜激光手术治疗双胎输血综合征后 3 岁时的神经发育损伤。

Neurodevelopmental impairment at 3 years of age after fetoscopic laser surgery for twin-to-twin transfusion syndrome.

机构信息

Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.

Division of Obstetrics, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.

出版信息

Prenat Diagn. 2020 Jul;40(8):1013-1019. doi: 10.1002/pd.5726. Epub 2020 May 13.

DOI:10.1002/pd.5726

PMID:32362029

Abstract

BACKGROUND

Data on neurodevelopmental outcomes of children surviving after fetoscopic laser surgery (FLS) for twin-to-twin transfusion syndrome (TTTS) are scarce.

METHODS

We retrospectively investigated children surviving after FLS for TTTS at 16 to 26 weeks' gestation between 2003 and 2014. Children were evaluated by standardized neurologic examinations using the Kyoto Scale 2001 at a corrected age of 3 years ± 6 months. Neurodevelopmental impairment (NDI) was defined as cerebral palsy (CP), bilateral blindness, bilateral deafness or a developmental quotient (DQ) < 70 points. Brain magnetic resonance imaging (MRI) was performed at term-equivalent age.

RESULTS

A total of 188 children from 110 twin pregnancies were evaluated. NDI was detected in 16/188 (8.5%) children, including six cases of CP (3.2%). No children had bilateral blindness or deafness. An earlier gestational age at delivery was associated with a higher incidence of NDI (P < .001). Abnormal brain MRI findings were detected in 9/16 (56%) of children with NDI, including 6/6 (100%) with CP.

CONCLUSION

The incidence of NDI in children following FLS at 3 years old was 8.5%. Prematurity is a strong risk factor for NDI. Brain MRI may predict the development of CP.

摘要

背景

关于接受胎儿镜激光手术（FLS）治疗双胎输血综合征（TTTS）后存活的儿童神经发育结局的数据很少。

方法

我们回顾性调查了 2003 年至 2014 年间在 16 至 26 孕周接受 FLS 治疗 TTTS 后存活的儿童。在 3 岁±6 个月的矫正年龄时，使用京都量表 2001 对儿童进行标准化的神经检查评估。神经发育障碍（NDI）定义为脑瘫（CP）、双侧失明、双侧耳聋或发育商（DQ）<70 分。在胎龄相等时进行脑磁共振成像（MRI）检查。

结果

共评估了来自 110 对双胎妊娠的 188 名儿童。188 名儿童中，有 16/188（8.5%）存在 NDI，包括 6 例 CP（3.2%）。没有儿童双侧失明或耳聋。分娩时的胎龄越早，NDI 的发生率越高（P<.001）。16 例存在 NDI 的儿童中有 9/16（56%）存在异常脑 MRI 发现，其中 6/6（100%）存在 CP。