Outcomes of extremely premature infants with twin-twin transfusion syndrome treated by laser therapy

J Perinatol. 2018 Nov;38(11):1548-1555. doi: 10.1038/s41372-018-0202-z. Epub 2018 Sep 3.

Abstract

Objective: To compare short-term and long-term outcomes of preterm infants born at <29 weeks of gestational age (GA) with twin-twin transfusion syndrome (TTTS) treated with laser therapy to preterm twin infants without TTTS.

Design: Retrospective case-control study comparing 33 preterm TTTS twins to 101 preterm diamniotic-dichorionic (di-di) twins born at our institution between 2006 and 2015.

Results: GA at birth were 26.4 ± 1.4 weeks (TTTS) and 26.9 ± 1.6 weeks (di-di) (p = 0.07). TTTS premature newborns were less exposed to antenatal steroids (p = 0.01), more frequently born by C-section (p = 0.005), received more surfactant therapy (p = 0.004, and were smaller for GA (p < 0.001). When adjusted for antenatal steroids and birth weight, TTTS status was not associated with increased mortality (HR 1.66, 95% CI 0.77-3.56, p = 0.20). No differences were found on neurodevelopmental outcomes at 18 months of corrected GA.

Conclusion: Premature TTTS newborns treated with fetal laser therapy had similar survival and neurodevelopmental outcomes compared to preterm di-di twins without TTTS.

MeSH terms

  • Female
  • Fetofetal Transfusion / complications
  • Fetofetal Transfusion / mortality
  • Fetofetal Transfusion / surgery*
  • Fetoscopy
  • Gestational Age
  • Humans
  • Infant
  • Infant, Extremely Premature*
  • Infant, Newborn
  • Laser Coagulation / methods*
  • Male
  • Neurodevelopmental Disorders / etiology*
  • Pregnancy
  • Pregnancy, Twin
  • Premature Birth / prevention & control
  • Proportional Hazards Models
  • Steroids / therapeutic use
  • Twins, Monozygotic

Substances

  • Steroids