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Neurodevelopmental Outcomes After Laser Therapy for Twin–Twin Transfusion Syndrome: A Systematic Review and Meta-Analysis

Rossi, A. Cristina MD; Vanderbilt, Douglas MD; Chmait, Ramen H. MD

doi: 10.1097/AOG.0b013e318231827f

OBJECTIVE: To perform a systematic review of the literature regarding the occurrence of neurologic morbidity, neurologic impairment, or neurologic morbidity and impairment of patients treated with laser therapy for twin–twin transfusion syndrome.

DATA SOURCES: The PubMed, MEDLINE, EMBASE databases and reference lists were searched up to December 2010 for studies describing outcomes in laser-treated twin–twin transfusion syndrome pregnancies.

METHODS FOR STUDY SELECTION: Inclusion criteria were twin–twin transfusion syndrome diagnosed with standard criteria and treated by laser therapy and neurologic morbidity and neurologic impairment collected at birth or 28 days after birth. Exclusion criteria were omission of at least one criterion; data in graphs or percentage; and non-English publications, letters, personal communications.

TABULATION, INTEGRATION AND RESULTS: Data recorded were rates and length of successful follow-up, age at diagnosis and type of neurologic morbidity, affected donors and recipients, prevalence of neurologic morbidity, and neurologic impairment for twin sets. From 15 articles, the incidence of neurologic morbidity at birth was 55 out of 895 (6.1%), without differences between donors and recipients (19/249, 7.6% compared with 16/273, 5.8%; odds ratio [OR] 1.36; 95% confidence interval [CI] 0.68–2.70). At follow-up, the incidence of neurologic impairment was 140 out of 1,255 (11.1%), with cerebral palsy the most frequent (60/151, 39.7%). Neurologic impairment was identified equally between donors and recipients (48/330, 14.5% compared with 54/364, 14.8%; OR 1.02; 95% CI 0.66–1.57), and between one survivor and two survivors for twin sets (24/139, 17.3% compared with 88/489, 18.0%; OR 0.67; 95% CI 0.18–2.49).

CONCLUSION: A small number (11.1%) of cases of twin–twin transfusion syndrome treated with laser therapy are affected with neurologic impairment that manifests during infancy. A strict follow-up of apparently healthy neonates is warranted.

Laser-treated twin transfusion syndrome is associated with 11% of neurologic damage at follow-up.

From the Clinic of Obstetrics and Gynecology, San Giacomo Hospital, Monopoli, Bari, Italy; and the Division of General Pediatrics, Department of Pediatrics, Division of Maternal-Fetal Medicine, and the Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California.

Corresponding author: A. Cristina Rossi, MD, Via Celentano, 42, 70121 Bari, Italy; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.