Ramen H Chmait1, Andrew H Chon1, Sheree M Schrager2, Arlyn Llanes1, Anita H Hamilton3, Douglas L Vanderbilt4. 1. a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , Keck School of Medicine, University of Southern California , Los Angeles , CA , USA. 2. b Division of Hospital Medicine, Department of Pediatrics , Children's Hospital Los Angeles , Los Angeles , CA , USA. 3. c Division of Neurology, Department of Surgery , Keck School of Medicine, University of Southern California , Los Angeles , CA , USA. 4. d Division of General Pediatrics, Department of Pediatrics , Keck School of Medicine, University of Southern California , Los Angeles , CA , USA.
Abstract
OBJECTIVE: The objective of this study is to assess whether postnatally detected cerebral abnormalities are predictive of neurodevelopmental impairment (NDI) in survivors of twin-twin transfusion syndrome (TTTS) that underwent laser surgery. MATERIALS AND METHODS: Ninety-nine children treated for TTTS had neurodevelopmental assessment at age 2-years (±6 weeks). 'High-risk survivors' had cerebral imaging in the neonatal period. 'High-risk survivors' were defined as (1) delivered at <32 weeks; or (2) cerebral imaging clinically indicated. NDI was a composite outcome of: Battelle Developmental Inventory 2nd edition (BDI-2) score <70, cerebral palsy, blindness, and/or deafness. Multilevel logistic regression with robust standard errors was used to evaluate associations between cerebral lesions and NDI. RESULTS: Fifty-six children were 'high-risk survivors' and had neonatal cerebral imaging. Ten twins (18%) had at least one cerebral lesion, including grade 1-2 intraventricular hemorrhage (8), cystic periventricular leukomalacia (2), ventriculomegaly (1), and bilateral subependymal cyst (1). The risk of NDI in the 'high-risk survivors' was 7% (4/56) compared with 0% (0/43) in the remaining group. Among 'high-risk survivors', cerebral lesions were a significant risk factor for NDI (OR = 19.28, p < .001). CONCLUSIONS: Among 'high-risk survivors' of TTTS treated with laser surgery, cerebral lesions identified on neonatal imaging were associated with NDI at 2-years.
OBJECTIVE: The objective of this study is to assess whether postnatally detected cerebral abnormalities are predictive of neurodevelopmental impairment (NDI) in survivors of twin-twin transfusion syndrome (TTTS) that underwent laser surgery. MATERIALS AND METHODS: Ninety-nine children treated for TTTS had neurodevelopmental assessment at age 2-years (±6 weeks). 'High-risk survivors' had cerebral imaging in the neonatal period. 'High-risk survivors' were defined as (1) delivered at <32 weeks; or (2) cerebral imaging clinically indicated. NDI was a composite outcome of: Battelle Developmental Inventory 2nd edition (BDI-2) score <70, cerebral palsy, blindness, and/or deafness. Multilevel logistic regression with robust standard errors was used to evaluate associations between cerebral lesions and NDI. RESULTS: Fifty-six children were 'high-risk survivors' and had neonatal cerebral imaging. Ten twins (18%) had at least one cerebral lesion, including grade 1-2 intraventricular hemorrhage (8), cystic periventricular leukomalacia (2), ventriculomegaly (1), and bilateral subependymal cyst (1). The risk of NDI in the 'high-risk survivors' was 7% (4/56) compared with 0% (0/43) in the remaining group. Among 'high-risk survivors', cerebral lesions were a significant risk factor for NDI (OR = 19.28, p < .001). CONCLUSIONS: Among 'high-risk survivors' of TTTS treated with laser surgery, cerebral lesions identified on neonatal imaging were associated with NDI at 2-years.
Authors: Andrew H Chon; Mary Rose Mamey; Sheree M Schrager; Douglas L Vanderbilt; Ramen H Chmait Journal: Prenat Diagn Date: 2018-01-24 Impact factor: 3.050
Authors: Marjolijn S Spruijt; Enrico Lopriore; Ratna N G B Tan; Femke Slaghekke; Frans J C M Klumper; Johanna M Middeldorp; Monique C Haak; Dick Oepkes; Monique Rijken; Jeanine M M van Klink Journal: J Clin Med Date: 2019-08-15 Impact factor: 4.241
Authors: Vidya Rajagopalan; Karam Ashouri; Arlyn Llanes; Douglas L Vanderbilt; Natasha Lepore; Stefan Bluml; Hollie A Lai; Jessica Wisnowski; Andrew H Chon; Ramen H Chmait Journal: Prenat Diagn Date: 2020-11-26 Impact factor: 3.050