Long-Term Outcome of Monochorionic Twins after Fetoscopic Laser Therapy Compared to Matched Dichorionic Twins
| Autor: | Margaret Hüsler, Franziska Krähenmann, Giancarlo Natalucci, Nicole Ochsenbein-Kölble, Roland Zimmermann, Ladina Rüegg |
|---|---|
| Přispěvatelé: | University of Zurich, Ochsenbein-Kölble, Nicole |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Laser surgery
Embryology Pediatrics medicine.medical_specialty Birth weight medicine.medical_treatment 610 Medicine & health Gestational Age Twin-to-twin transfusion syndrome Fetoscopy 03 medical and health sciences 0302 clinical medicine Pregnancy medicine Twins Dizygotic 2741 Radiology Nuclear Medicine and Imaging Humans Radiology Nuclear Medicine and imaging 030212 general & internal medicine 2735 Pediatrics Perinatology and Child Health Child Birth Year Fetus 030219 obstetrics & reproductive medicine medicine.diagnostic_test business.industry Infant Newborn Obstetrics and Gynecology Gestational age 2729 Obstetrics and Gynecology General Medicine 2710 Embryology Fetofetal Transfusion medicine.disease 10027 Clinic for Neonatology Pediatrics Perinatology and Child Health Cohort Female Monochorionic twins Laser Therapy business Research Article |
| Zdroj: | Fetal Diagn Ther |
| Popis: | Introduction: The only causal therapy is fetoscopic laser surgery (FLS). The aims of this study were to analyze the long-term outcome of monochorionic twins treated by FLS, including their school career, need for therapy and special aid equipment, and free-time activities, and compare their outcome to matched dichorionic twins. Material and Methods: Among the 57 women treated at a single fetal treatment center between 2008 and 2017 with FLS because of twin-to-twin transfusion syndrome, 25 women with 42 children were included in the FLS group. The control group consisted of 16 dichorionic twin pairs matched for birth year, gestational age (GA), birth weight, and sex. The long-term outcome was assessed by a parental questionnaire and a standardized neurodevelopmental examination for children born before 32 gestational weeks or with a birth weight lower than 1500 g. They were also registered into the Swiss Neonatal Network database. The primary outcome was event-free survival, defined as normal neurology, behavior, vision, and hearing. The secondary outcomes were school career, need for therapy and special aid equipment, and free-time activities. Results: An event-free survival was found in 32 children (76%) in the laser and in 24 children (75%) in the control group (p = 0.91). Neurological anomalies were found in 5 children (12%) in the laser group and 3 children (9%) in the control group (p = 1.00). Multiple logistic regression analysis showed that GA at delivery was the only predictive factor for event-free survival. There were no significant differences regarding school career, therapies, or special aid equipment between the 2 groups. We found that children without FLS were involved in more free-time activities and needed fewer breaks during physical activity than children with FLS during pregnancy. Conclusion: The outcome of monochorionic twins treated with FLS is comparable to the outcome of dichorionic twins. Long-term neurodevelopment in the cohort was mainly dependent on GA at birth. |
| Databáze: | OpenAIRE |
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