Abstract:Objective To explore the clinical manifestations and short-term prognosis of twin-twin transfusion syndrome (TTTS) in neonates with different disease stages, receiving different intrauterine interventions, or as blood donors and recipients. Methods The study retrospectively collected 76 TTTS neonates who were hospitalized in the Neonatal Ward, Peking University Third Hospital. The participants were classified into mild TTTS (n=38) and severe TTTS groups (n=21), or into amnioreduction (n=20), laser surgery (n=21), and expectant therapy groups (n=32), or into donor (n=23) and recipient groups (n=30). Results The severe TTTS group had higher incidences of brain injury, heart disease, asphyxia, and renal damage and in-hospital mortality rate compared with the mild TTTS group, but the differences had no statistical significance. The laser surgery group displayed decreasing trends in the incidences of brain injury, heart disease, and renal damage and in-hospital mortality rate compared with the amnioreduction and expectant therapy groups. The recipient group had higher incidences of heart diseases and pathological jaundice than the donor group (P<0.05). The donor group had higher incidences of asphyxia and renal damage than the recipient group, but with no significant difference. Conclusions The neonates with severe TTTS have higher rates of organ damages and in-hospital mortality. Intrauterine laser surgery seems to lead to a better prognosis compared with the amnioreduction and expectant therapy. The recipients are more susceptible to heart diseases and pathological jaundice, whereas the donors are more susceptible to asphyxia and renal damage.
Lopriore E, Sueters M, Middeldorp JM, et al. Neonatal outcome in twin-to-twin transfusion syndrome treated with fetoscopic laser occlusion of vascular anastomoses[J]. J Pediatr, 2005, 147(5): 597-602.
[9]
Lopriore E, Oepkes D, Walther FJ. Neonatal morbidity in twin-twin transfusion syndrome[J]. Early Hum Dev, 2011, 87: 595-599.
[10]
Duncombe GJ, Dickinson JE, Evans SF. Perinatal characteristics and outcomes of pregnancies complicated by twin-twin transfusion syndrome[J]. Obstet Gynecol, 2003, 101(6): 1190-1196.
[11]
Dickison JE, Duncombe GJ, Evans SF, et al. The long term neurologic outcome of children from pregnancies complicated by twin-to-twin transfusion syndrome[J]. BJOG, 2005, 112(1): 63-68.
[12]
Senat MV, Deprest J, Boulvain M, et al. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome[J]. N Engl J Med, 2004, 351(2): 136-144.
Habli M, Michelfelder E, Cnota J. Prevalence and progression of recipient-twin cardiomyopathy in early-stage twin-twin transfusion syndrome[J]. Ultrasound Obstet Gynecol, 2012, 39(1): 63-68.
[15]
Lenclen R, Paupe A, Ciarlo G, et al. Neonatal outcome in preterm monochorionic twins with twin-to-twin transfusion syndrome after intrauterine treatment with amnioreduction or fetoscopic laser surgery: comparison with dichorionic twins[ J]. Am J Obstet Gynecol, 2007, 196: 450-457.
[16]
Graeve P, Banek C, Stegmann-Woessner G, et al. Neurodevelopmental outcome at 6 years of age after intrauterine laser therapy for twin-twin transfusion syndrome[J]. Acta Paediatr, 2012, 101(12): 1200-1205.
[17]
Stirnemann JJ, Mougeot M, Proulx F, et al. Profiling fetal cardiac function in twin-twin transfusion syndrome[J]. Ultrasound Obstet Gynecol, 2010, 35(1): 19-27.
[18]
Rychik J, Tian Z, Bebbington M, et al. The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease[J]. Am J Obstet Gynecol, 2007, 197(4): 392.e1-392. e8.
[19]
Cincotta RB, Gray PH, Phythian G. Long term outcome of twin-twin transfusion syndrome[J]. Arch Dis Child Fetal Neonatal Ed, 2000, 83(3): F171-F176.