Neurodevelopmental outcome at 2 years in twin-twin transfusion syndrome survivors randomized for the Solomon trial

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• 作者：Jeanine M.M. van Klink ; MSc^a ; ^{j.m.m.van_klink@lumc.nl" class="auth_mail" title="E-mail the corresponding author} ; Femke Slaghekke ; MD ; PhD^b ; Marina A. Balestriero ; MSc^c ; Barbara Scelsa ; MD^c ; Paola Introvini ; MD^d ; Mariangela Rustico ; MD^e ; Stefano Faiola ; MD^e ; Monique Rijken ; MD ; PhD^a ; Hendrik M. Koopman ; PhD^f ; Johanna M. Middeldorp ; MD ; PhD^b ; Dick Oepkes ; MD ; PhD^b ; Enrico Lopriore ; MD ; PhD^a
• 关键词：laser surgery ; neurodevelopmental outcome ; Solomon ; twin-twin transfusion syndrome
• 刊名：American Journal of Obstetrics and Gynecology
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：214
• 期：1
• 页码：113.e1-113.e7
• 全文大小：336 K

文摘

The preferred treatment for twin-twin transfusion syndrome is fetoscopic laser coagulation of inter-twin vascular anastomoses on the monochorionic placenta. Severe postoperative complications can occur when inter-twin vascular anastomoses remain patent including twin-anemia polycythemia sequence or recurrent twin-twin transfusion syndrome. To minimize the occurrence of residual anastomoses, a modified laser surgery technique, the Solomon technique, was developed in which the entire vascular equator is coagulated. In the Solomon randomized controlled trial (NTR1245), the Solomon technique was associated with a significant reduction in twin-anemia polycythemia sequence and recurrence of twin-twin transfusion syndrome when compared with the standard laser surgery technique. Although a significant improvement in perinatal outcome was shown after the Solomon technique, the clinical importance should also be ascertained with long-term follow-up evaluation of the surviving children.

bsSec_2">Objective

bspara0015">The purpose of this study was to compare the long-term neurodevelopmental outcome in surviving children with twin-twin transfusion syndrome who were included in the Solomon randomized trial and treated with either the Solomon technique or standard laser surgery technique.

bsSec_3">Study Design

bspara0020">Routine standardized follow-up evaluation in survivors, at least 2 years after the estimated date of delivery, was performed at 2 of the 5 centers that participated in the Solomon trial: Buzzi Hospital Milan (Italy) and Leiden University Medical Center (The Netherlands). The primary outcome of this follow-up study was survival without long-term neurodevelopmental impairment at age 2 years. Neurodevelopmental impairment was defined as cerebral palsy, cognitive and/or motor development score of <85, bilateral blindness, or deafness. Cognitive and motor development was evaluated with the use of Bayley-III. All analyses per fetus, neonate, or child were conducted with the generalized estimated equation module to account for the effect that observations between co-twins are not independent.

bsSec_4">Results

bspara0025">The primary outcome (survival without neurodevelopmental impairment) was detected in 95 of 141 cases (67%) in the Solomon group and in 99 of 146 cases (68%) in the standard group (P = .92). Neurodevelopmental impairment in long-term survivors who were included for follow-up evaluation was detected in 12 of 107 cases (11%) in the Solomon and in 10 of 109 cases (9%) in the standard group (P = .61). Neurodevelopmental impairment was due to cerebral palsy in 1 case (1%; spastic unilateral) in the Solomon group and in 2 cases (2%; spastic unilateral and spastic bilateral) in the standard group (P = .58). Cognitive development <85 cases was detected in 2 of 105 children (2%) in the Solomon group and in 6 of 106 children (6%) in the standard group (P = .23). Motor development <85 occurred in 8 of 103 children (8%) in the Solomon group and 3 of 104 children (3%) in the standard group (P = .23).

bsSec_5">Conclusion

bspara0030">We found no difference in survival without neurodevelopmental impairment between the Solomon and standard laser techniques. In view of the reduction of short-term complications and the absence of increased adverse long-term effects, these data support the use of the Solomon technique in the treatment of twin-twin transfusion syndrome.