학술논문
Developmental outcomes for survivors of placental laser photocoagulation for the management of twin-to-twin transfusion syndrome.
Document Type
Academic Journal
Author
Guzys A; Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.; Reid SM; Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.; Department of Paediatrics, University of Melbourne, Melbourne, Australia.; Department of Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Australia.; Bolch C; Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.; Reddihough DS; Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.; Department of Paediatrics, University of Melbourne, Melbourne, Australia.; Department of Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Australia.; Teoh M; Fetal Diagnostics Unit, Monash Health, Melbourne, Australia.; Victorian Fetal Therapy Service, Monash Health, Melbourne, Australia.; Palma-Dias R; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia.; Ultrasound Services, The Royal Women's Hospital, Melbourne, Australia.; Fung A; Mercy Perinatal, Mercy Hospital for Women, Melbourne, Australia.; Cole S; Division of Maternity Services, The Royal Women's Hospital, Melbourne, Australia.; Hodges R; Women's and Newborn Program, Monash Health, Melbourne, Australia.; Fahey M; Paediatric Neurology Unit, Monash Children's Hospital, Melbourne, Australia.; Department of Paediatrics, Monash University, Melbourne, Australia.; Walker SP; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia. spwalker@unimelb.edu.au.; Mercy Perinatal, Mercy Hospital for Women, Melbourne, Australia. spwalker@unimelb.edu.au.
Source
Publisher: BioMed Central Country of Publication: England NLM ID: 100967799 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2393 (Electronic) Linking ISSN: 14712393 NLM ISO Abbreviation: BMC Pregnancy Childbirth Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Fetoscopic laser coagulation of placental anastomoses reverses the pathological process in twin-to-twin transfusion syndrome, thereby increasing survival, but there are a paucity of studies addressing long-term neurodevelopmental outcome of survivors. This study aimed to ascertain the presence of neurodevelopmental disabilities in child survivors of monochorionic pregnancies managed by placental laser photocoagulation in the Australian state of Victoria.
Methods: All pregnancies undergoing placental laser photocoagulation with the Victorian Fetal Therapy Service between 2006-2017 were included. Information on each surviving child, including demographics, perinatal course, and developmental progress was collected from parents, and consent was sought to complete the Child Behaviour Checklist. Interviewers evaluated whether this information was consistent with a diagnosis of any of 14 neurodevelopmental conditions. A three-tiered outcome measure was allocated for each child: (1) unimpaired or developmentally normal, (2) mild or moderate neurological impairment, or (3) severe neurological impairment. Clinical predictors for adverse outcome were identified.
Results: Of 116 pregnancies (113 twin, 3 triplet), 96 (83%) resulted in 1 + surviving fetuses. 57/113 (50%) twin pregnancies resulted in 2 survivors, 36 (32%) in 1 survivor, and 20 (18%) in no survivors. Of the 235 fetuses, 154 (65.5%) survived to follow-up. Survival increased from 59% in 2006-2008 to 73% in 2015-2017. 90/154 (58%) survivors were followed up at a mean age of 7.5 [SD 3.0] years. Based on parental interview and Child Behaviour Checklist data, 28/90 (31%) participants were assessed as having neurodevelopmental impairment, 27 of mild-moderate severity and 1 severe. Speech/language disorders, attention deficit (hyperactivity) disorders, and fine motor impairment were most common. Neonatal length of stay conferred the highest risk of impairment.
Conclusion: Substantial variation exists between fetal therapy services in the type and length of neonatal follow-up following fetoscopic laser coagulation, contributing to a lack of data on long-term outcomes. The findings from this study support increasingly urgent calls to undertake systematic and sustained follow-up of fetoscopic laser coagulation survivors until school age. Information from this study may assist parents in their decision-making when offered fetal surgery. Importantly, it highlights a group for targeted surveillance and early intervention.
(© 2023. BioMed Central Ltd., part of Springer Nature.)
Methods: All pregnancies undergoing placental laser photocoagulation with the Victorian Fetal Therapy Service between 2006-2017 were included. Information on each surviving child, including demographics, perinatal course, and developmental progress was collected from parents, and consent was sought to complete the Child Behaviour Checklist. Interviewers evaluated whether this information was consistent with a diagnosis of any of 14 neurodevelopmental conditions. A three-tiered outcome measure was allocated for each child: (1) unimpaired or developmentally normal, (2) mild or moderate neurological impairment, or (3) severe neurological impairment. Clinical predictors for adverse outcome were identified.
Results: Of 116 pregnancies (113 twin, 3 triplet), 96 (83%) resulted in 1 + surviving fetuses. 57/113 (50%) twin pregnancies resulted in 2 survivors, 36 (32%) in 1 survivor, and 20 (18%) in no survivors. Of the 235 fetuses, 154 (65.5%) survived to follow-up. Survival increased from 59% in 2006-2008 to 73% in 2015-2017. 90/154 (58%) survivors were followed up at a mean age of 7.5 [SD 3.0] years. Based on parental interview and Child Behaviour Checklist data, 28/90 (31%) participants were assessed as having neurodevelopmental impairment, 27 of mild-moderate severity and 1 severe. Speech/language disorders, attention deficit (hyperactivity) disorders, and fine motor impairment were most common. Neonatal length of stay conferred the highest risk of impairment.
Conclusion: Substantial variation exists between fetal therapy services in the type and length of neonatal follow-up following fetoscopic laser coagulation, contributing to a lack of data on long-term outcomes. The findings from this study support increasingly urgent calls to undertake systematic and sustained follow-up of fetoscopic laser coagulation survivors until school age. Information from this study may assist parents in their decision-making when offered fetal surgery. Importantly, it highlights a group for targeted surveillance and early intervention.
(© 2023. BioMed Central Ltd., part of Springer Nature.)