Long-term outcome of monochorionic twins after fetoscopic laser therapy compared to matched dichorionic twins

Introduction The aims of this study were to analyze the long-term outcome of monochorionic twins treated by FLA and compare their outcome to dichorionic twins.

Material and methods Among the 57 women treated at a single fetal treatment center between 2008 and 2017 with FLA because of TTTS, 25 women with 42 children were included in the FLA group. The control group consisted of 32 dichorionic twins matched for birth year, gestational age, birth weight and sex. The long-term outcome was assessed by parental questionnaire and a neurodevelopmental examination for the children born before 32 gestational weeks or birth weight lower than 1500g. They were also registered into the Swiss Neonatal Network database. The primary outcome was the event-free survival defined as normal neurology, behavior, vision and hearing. Secondary outcome were school career, need for therapy and special aid equipment.

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 (12%) in the laser and 3 (9%) in the control group (p = 1.00). Multiple logistic regression analysis showed that gestational age 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 two groups.

Conclusion The outcome of monochorionic twins treated with FLA is comparable to the outcome of dichorionic twins. Long-term neurodevelopment in the cohort was mainly dependent on gestational age at birth.

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Artikel online veröffentlicht:
07. Oktober 2020