Twin-twin transfusion syndrome: neurodevelopmental screening test

Uso da Escala de Avaliação do Desenvolvimento Infantil Bayley III em Crianças Brasileiras: Revisão Sistemática

Resumo O objetivo deste estudo foi realizar uma revisão sistemática de pesquisas com a Escala Bayley-III em crianças brasileiras. Foram seguidas as recomendações PRISMA, com buscas nas bases MEDLINE, LILACS, SCIELO, Scopus, PUBMED e Web of Science. A revisão incluiu artigos publicados nos idiomas português e inglês entre 2006 e 2018. Foram encontrados 856 estudos e, após análise do título e resumo, selecionaram-se 24. Os estudos avaliaram o desenvolvimento de crianças prematuras, típicas, frequentadoras de creche, e atípicas,sendo a maioria residente na região Sudeste e com até 12 meses de idade. A literatura apontou a prevalência de fatores de risco e altos percentuais de suspeitas e atrasos do desenvolvimento neuropsicomotor entre as crianças brasileiras avaliadas.

Twin-To-Twin Transfusion Syndrome Donor and Recipient and Their Subsequent Cognitive Functioning in Late Childhood as Juvenile Athletes-A Case Study

Objective: It is estimated that twin-to-twin transfusion syndrome (TTTS) occurs in 10–15% of monochorionic twin pregnancies. One of the fetuses takes on the role of donor and the other of recipient. The treatment administered involves serial amnioreduction and laser photocoagulation of the communicating blood vessels. After TTTS, children may have deficiencies in psychomotor functioning, in particular in cognitive functions, expressive language, and motor skills. Few scientific reports indicate that twins after TTTS do not demonstrate significant differences in tests which measure intellectual functioning. Methods: The cognitive functioning of twins in the late childhood period was compared using the following tools: an analysis of their medical history, an interview with their parents, and neuropsychological tests allowing the evaluation of their whole profile of cognitive functions. Case Study: Cognitive functioning in the late childhood period was analyzed in a pair of 11-year-old male twins (juvenile athletes), a donor and a recipient, who had developed TTTS syndrome in the prenatal period. Results: Comparison of the cognitive functioning profile of the donor and recipient revealed that children with a history of TTTS develop normally in terms of cognitive and motor functioning in late childhood. A comparative analysis of the donor and recipient was more favorable for the recipient, who had a higher level of general intelligence, visual–motor memory, and semantic fluency. Conclusions: The fact that both the donor and the recipient chose to pursue athletics suggests that gross motor skills are their strongest suit. Playing sports as a method of rehabilitation of cognitive function of children born prematurely after TTTS could contribute to the improvement of cognitive functioning.

Neurological complications after therapy for fetal-fetal transfusion syndrome: a systematic review of the outcomes at 24 months

OBJECTIVE

The main objective of this study was to review the available scientific evidence about mid-term neurological outcomes in twins after laser therapy for twin-to-twin transfusion syndrome (TTTS).

METHODS

A systematic review of studies on neurodevelopmental outcomes (cognition, motor development, communication skills and cerebral palsy) of twins after laser therapy for TTTS was conducted. Outcomes at 24 months of age and the use of validated scales for assessment were the selected criteria. Electronic and manual research identified 25 studies, and nine of them were eligible for the review.

RESULTS

The global mean rate of neurological injury in twins treated with laser was 14.07%. The mean rate of cognitive impairment was 8.41%, 11.14% for motor delay, 16.5% for communication delay and 5.73% for cerebral palsy. These rates were higher than the results found in dichorionic twins, but lower than the results found in twins treated with amnio-reductions or conservative management.

CONCLUSION

Laser therapy is associated with a lower rate of neurological injury at 24 months of age compared to other therapeutic techniques. This tendency was also observed with specific incidences regarding cognition, motor skills and cerebral palsy.