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Laser Surgery for Twin-to-Twin-Transfusion-Syndrome and Behavioral Outcomes at 2 Years

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BACKGROUND AND PURPOSE:

  • Brandsma et al. (Arch Dis Child Fetal Neonatal Ed., 2019) sought to determine behavioral outcomes and related risk-factors in Twin-to-Twin-Transfusion-Syndrome (TTTS) survivors following laser treatment

METHODS:

  • Observational cohort study
  • Participants
    • TTTS survivors in The Netherlands
    • Undergoing behavioral assessment at 2 years
  • Interventions
    • Parents completed the Child Behavior Checklist for their twins
    • Antenatal, neonatal and follow-up data were collected
    • Bayley III and a neurological exam derived from the database
  • Primary outcomes
    • Incidence of behavioral problems
    • Risk factors for behavioral problems

RESULTS:

  • 417 Child Behavior Checklist questionnaires were completed (81% of eligible children)
    • Mean gestational age at birth: 32.8 weeks
  • No difference in total behavioral problems between TTTS group and general Dutch population (p=0.12)
    • TTTS group: 8%
    • General population: 10%
  • Whether the twin was the “donor” or the “recipient” before TTTS treatment did not alter results (p=0.84)
  • Severe neurodevelopmental impairment was more frequent in the children with behavioral problems
  • High maternal educational level was associated with lower behavioral problem scores (p=0.01)

CONCLUSION:

  • TTTS laser treatment is not associated with more behavioral problems at 2 years of age
  • Behavior problems were more frequent in twins with severe neurodevelopmental impairment and the authors state

This finding suggests that caregivers and healthcare professionals need to be aware of comorbid behavioural problems in children with severe impairments including cognitive and motor delay

Learn More – Primary Sources:

Behavioural outcome in twin–twin transfusion syndrome survivors treated with laser surgery

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