Background
Multiple pregnancy and types of twinning
Pathophysiology of twin-to-twin transfusion syndrome
Natural history
Selective Fetoscopic laser photocoagulation of placental anastomoses (SFLP or “laser surgery”)
Australian experience with laser surgery, and the Victorian fetal therapy service (VFTS)
Neurodevelopmental outcomes following TTTS
Author and year | Number and age of participants | Measures | Outcomes |
---|---|---|---|
Campos, D., et al., (2016) [35] | N = 33 monochorionic diamniotic twins (post-laser), and N = 22 term singletons Birth to 12 months, corrected for prematurity | Bayley Scales of Infant Development, Clinical examination of TTTS group. Two assessments, in first and second 6 months of life. | Cerebral palsy in 18%, strabismus in 9%, microcephaly in 3% of TTTS group. Significant difference between groups in prevalence of cognitive and fine motor deficits apparent by 6 months (greater risk in TTTS group); by 12 months, significantly greater prevalence of deficits in all domains for TTTS group Comparative results at second assessment not provided (table of first assessment repeated in error). Donors 7 times increased risk of adverse outcomes c.f. recipients; donor status and low socioeconomic status, and cardiorespiratory disease were associated with poorer expressive communication & fine motor skills respectively |
Müllers, S. et al., (2015) [36] | N = 106 (post-laser). Median age 4 years (range 6 mo – 7 yrs) (correction for prematurity not specified) | Individual correspondence and paediatric evaluation (details not specified) | Ongoing neurodevelopmental concerns in 14% (speech and language concerns n = 7, behavioural concerns n = 2, mild motor delay n = 2, mild cerebral palsy n = 2, major cerebral palsy n = 2) |
Tosello, B. et al., (2014) [29]. | N = 35 (post-laser). Median age 37 months, mean 30 mo (range 4 mo - 5 yrs) | Neurological assessment at discharge from maternity hospital. Ages and Stages Questionnaire (ASQ) at up to 5 years | As neonates, ≈7% neurologically abnormal (≈93% normal). At follow-up, ≈31% abnormal based on ASQ (≈69% normal), ≈6% severely neurologically abnormal (cerebral palsy). Of children found to be abnormal at follow-up, 45% had not been detected on routine medical review. Donor status and birth < 32 weeks significantly associated with adverse neurosensory outcome as neonates. No correlations at follow-up between outcome and donor status, severity of TTTS or other variables (but small numbers) |
Sago, H. et al., (2010) [37] | N = 275 (post-laser). Age 6 months (correction for prematurity not specified) | Review of cerebral imaging & clinical assessment by paediatrician (details not specified) | Major neurological disability in ≈5% (severe IVH, cystic PVL, CP, hydrocephalus, ventriculomegaly, or multiple infarcts) |
Study aims
Method
Study design
Study setting
Participants
Number of participants
Procedure: Recruitment strategy
Loss to follow-up
Measures: Core components
Pre-assessment completion of standardised screening questionnaires
Age of participant | |||
---|---|---|---|
24 – 36mo | 3y – 6y 11mo | 7y + | |
General Cognition (administered by paediatric psychologist) | |||
Cognitive Scale from Bayley Scales of Infant and Toddler Development 3rd Ed (Bayley–III)*** | ✔ | ||
Wechsler Preschool and Primary Scale of Intelligence 4th Ed (WPPSI-IV) Core subtests (30–60 min) | ✔ | ||
Wechsler Intelligence Scale for Children 5th Ed (WISC-V) Core subtests (60 mins) | ✔ | ||
Motor Skills (administered by paediatric occupational therapist or physiotherapist) | |||
Fine & Gross Motor Scales (Bayley-III)*** | ✔ | ||
Movement Assessment Battery for Children 2nd Ed (MABC-2)* (20–40 min) | ✔ | ✔ | |
Gross Motor Function Classification Score (GMFCS-E&R) if applicable (5–20 min) | ✔ | ✔ | ✔ |
Manual Ability Classification Score (MACS) if applicable | ✔ | ✔ | ✔ |
Language and Communication (administered by paediatric speech therapist) | |||
Receptive & Expressive Scales (Bayley-III)*** | ✔ | ||
Clinical Evaluation of Language Fundamentals Preschool – 2 (CELF-P2)* Core subtests (30–60 min) | ✔ | ||
Clinical Evaluation of Language Fundamentals (CELF-IV) Core subtests (30–60 min) | ✔ | ||
Communication Function Classification System (CFCS) if applicable | ✔ | ✔ | ✔ |
Social/Emotional / Behavioural skills and General Development (parent report questionnaire) | |||
Infant Toddler Social Emotional Assessment (ITSEA) (25–30 min) | ✔ | ||
Child Behavior Checklist (CBCL) (15 mins) | ✔ | ✔ | |
Ages and Stages Questionnaire (ASQ-3)** (10–15 min) | ✔ | ✔ | |
Academic Achievement (administered by paediatric psychologist) | |||
Wide Range Achievement Test 4th Ed (WRAT-4) (select subtests) (15–25 min) | ✔ |
Medical assessment
Standardised developmental assessments
Measures: Optional component
Medical information from hospital of birth and subsequent health care providers
Outcome measures
Outcome by overall neurological status
Group 1: Unimpaired | Group 2: Mild neurological and/or developmental impairment | Group 3: Severe neurological and/or developmental impairment |
---|---|---|
NO neurological findings on history / examination, AND no functional impairment | ANY neurological findings on history/examination which are objectively mild or moderate AND which DO NOT result in severe functional impairment
Examples: Strabismus (squint), Mild talipes (club foot), Mild cerebral palsy (GMFCS I-II)
| ANY neurological findings on history/examination which are objectively moderate or severe AND which result in severe functional impairment
Examples: Moderate-Severe cerebral palsy (GMFCS 3–5), Severe visual impairment
|
NO neurodevelopmental delay or disability in any domain (either on clinical assessment or according to standardised measures) AND no functional impairment | ANY neurodevelopmental delay or disability (in one or more domain/s, either on clinical assessment or according to standardised measures), which is objectively mild or moderate, AND which DOES NOT result in severe functional impairment
Examples: Mild intellectual disability (IQ 50-70), Mild Autism Spectrum Disorder, Mild Isolated Speech Delay
| ANY neurodevelopmental delay or disability (in one or more domain/s, (either on clinical assessment or according to standardised measures), which is objectively moderate or severe, AND which results in severe functional impairment
Examples: Moderate or Profound intellectual disability (IQ 35–49, or < 30), Moderate or severe Autism Spectrum disorder
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