Neurodevelopmental Outcome After Fetoscopic Laser Surgery for Twin-twin Transfusion Syndrome:A Systematic Review of Follow-up Studies from the Last Decade

Objective:To review the literature on long-term neurodevelopmental outcome after fetoscopic laser surgery for twin-twin transfusion syndrome(TTTS).Methods:A literature search in PubMed,Embase,Emcare,Web of Science,Cochrane library,and Academic Search Premier was performed.Inclusion criteria were studies between 2009 and 2019 in TTTS-survivors treated with fetoscopic laser surgery and followed-up after the neonatal period with cognitive developmental tests and neurologic exams.Exclusion criteria were non-English articles and reviews,case reports,letters,and guidelines.Results:Nineteen articles were included.Long-term severe neurodevelopmental impairment(NDI)was reported by seven and ranged from 4.0%to 18.0%with a mean of 9.7%(95%confidence interval(CI):7.8-11.5).The prevalence of cerebral palsy ranged from 1.6%to 18.2%,with a mean of 5.1%(95%CI:4.1-6.2).The mean prevalence of minor impairment was 13.7%(95%CI:11.4-16.0).However,only 78.9%(15/19)studies used a validated neurodevelopmental test.As studies lack uniform definitions of primary outcome,timing of follow-up,inclusion criteria,and methods,adequate comparison is hampered.Conclusion:The prevalence of severe NDI and cerebral palsy after fetoscopic laser surgery for TTTS in the last decade remains stable around 9.7%and 5.1%,respectively.International agreements on primary outcomes,methods,and follow-up are necessary to improve the knowledge of NDI in TTTS-survivors.