Prevalence and risk factors of cerebral lesions in neonates after laser surgery for twin-twin transfusion syndrome

Objective To identify risk factors for cerebral lesions among survivors of twin-twin transfusion syndrome treated with laser surgery. Study Design A multilevel regression analysis examined risk factors for neonatal cerebral lesions identified by imaging. Imaging was routine in “high-risk survivors,”...

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Published in:American journal of obstetrics and gynecology 2012-10, Vol.207 (4), p.320.e1-320.e6
Main Authors: Vanderbilt, Douglas L., MD, Schrager, Sheree M., PhD, Llanes, Arlyn, RN, Chmait, Ramen H., MD
Format: Article
Language:English
Subjects:
Biological and medical sciences
cerebral lesions
Female
Fetofetal Transfusion - surgery
Fetoscopy - adverse effects
Gynecology. Andrology. Obstetrics
Humans
Hydrocephalus - epidemiology
Hydrocephalus - etiology
imaging
Infant, Newborn
Infant, Premature
Intracranial Hemorrhages - epidemiology
Intracranial Hemorrhages - etiology
Laser Therapy - adverse effects
Leukomalacia, Periventricular - epidemiology
Leukomalacia, Periventricular - etiology
Medical sciences
neurological
Obstetrics and Gynecology
outcome
Pregnancy
Prevalence
Risk Factors
twin-twin transfusion syndrome
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container_title American journal of obstetrics and gynecology
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creator Vanderbilt, Douglas L., MD
Schrager, Sheree M., PhD
Llanes, Arlyn, RN
Chmait, Ramen H., MD
description Objective To identify risk factors for cerebral lesions among survivors of twin-twin transfusion syndrome treated with laser surgery. Study Design A multilevel regression analysis examined risk factors for neonatal cerebral lesions identified by imaging. Imaging was routine in “high-risk survivors,” defined as those delivered at
doi_str_mv 10.1016/j.ajog.2012.06.031
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Study Design A multilevel regression analysis examined risk factors for neonatal cerebral lesions identified by imaging. Imaging was routine in “high-risk survivors,” defined as those delivered at &lt;32 weeks' gestation, and by clinical indications if born later. Severe lesions were defined as: intraventricular hemorrhage grade III-IV, cystic periventricular leukomalacia, ventriculomegaly and/or hydrocephalus, microcephaly, infarctions, porencephalic/Dandy-Walker cysts, or bilateral other cysts. Results For 262 consecutive laser-treated twin-twin transfusion syndrome patients, 18 neonates had severe lesions identified among 427 individual survivors (4.2%) and 242 “high-risk survivors” (7.4%). Forty-six newborns had any cerebral lesion, resulting in lesion rates of 10.8%-19.0%. Delivery &lt;32 weeks' (odds ratio, 4.95; P &lt; .001) and &lt;28 weeks' (odds ratio, 6.25; P &lt; .001) gestation were associated with increased likelihood of any cerebral lesion. Conclusion This cohort showed low rates (4-7%) of severe neonatal cerebral lesions, with prematurity being the primary risk factor.</description><identifier>ISSN: 0002-9378</identifier><identifier>EISSN: 1097-6868</identifier><identifier>DOI: 10.1016/j.ajog.2012.06.031</identifier><identifier>PMID: 23021698</identifier><identifier>CODEN: AJOGAH</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Biological and medical sciences ; cerebral lesions ; Female ; Fetofetal Transfusion - surgery ; Fetoscopy - adverse effects ; Gynecology. Andrology. Obstetrics ; Humans ; Hydrocephalus - epidemiology ; Hydrocephalus - etiology ; imaging ; Infant, Newborn ; Infant, Premature ; Intracranial Hemorrhages - epidemiology ; Intracranial Hemorrhages - etiology ; Laser Therapy - adverse effects ; Leukomalacia, Periventricular - epidemiology ; Leukomalacia, Periventricular - etiology ; Medical sciences ; neurological ; Obstetrics and Gynecology ; outcome ; Pregnancy ; Prevalence ; Risk Factors ; twin-twin transfusion syndrome</subject><ispartof>American journal of obstetrics and gynecology, 2012-10, Vol.207 (4), p.320.e1-320.e6</ispartof><rights>Mosby, Inc.</rights><rights>2012 Mosby, Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 Mosby, Inc. All rights reserved.</rights><rights>2012 Mosby, Inc. All rights reserved 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c540t-4fe8d285f0221b9b318364e57f63aa592bd381fdb45d04ca5d07c44adfd550f53</citedby><cites>FETCH-LOGICAL-c540t-4fe8d285f0221b9b318364e57f63aa592bd381fdb45d04ca5d07c44adfd550f53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,309,310,314,780,784,789,790,885,23930,23931,25140,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=26449984$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23021698$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vanderbilt, Douglas L., MD</creatorcontrib><creatorcontrib>Schrager, Sheree M., PhD</creatorcontrib><creatorcontrib>Llanes, Arlyn, RN</creatorcontrib><creatorcontrib>Chmait, Ramen H., MD</creatorcontrib><title>Prevalence and risk factors of cerebral lesions in neonates after laser surgery for twin-twin transfusion syndrome</title><title>American journal of obstetrics and gynecology</title><addtitle>Am J Obstet Gynecol</addtitle><description>Objective To identify risk factors for cerebral lesions among survivors of twin-twin transfusion syndrome treated with laser surgery. Study Design A multilevel regression analysis examined risk factors for neonatal cerebral lesions identified by imaging. Imaging was routine in “high-risk survivors,” defined as those delivered at &lt;32 weeks' gestation, and by clinical indications if born later. Severe lesions were defined as: intraventricular hemorrhage grade III-IV, cystic periventricular leukomalacia, ventriculomegaly and/or hydrocephalus, microcephaly, infarctions, porencephalic/Dandy-Walker cysts, or bilateral other cysts. Results For 262 consecutive laser-treated twin-twin transfusion syndrome patients, 18 neonates had severe lesions identified among 427 individual survivors (4.2%) and 242 “high-risk survivors” (7.4%). Forty-six newborns had any cerebral lesion, resulting in lesion rates of 10.8%-19.0%. Delivery &lt;32 weeks' (odds ratio, 4.95; P &lt; .001) and &lt;28 weeks' (odds ratio, 6.25; P &lt; .001) gestation were associated with increased likelihood of any cerebral lesion. Conclusion This cohort showed low rates (4-7%) of severe neonatal cerebral lesions, with prematurity being the primary risk factor.</description><subject>Biological and medical sciences</subject><subject>cerebral lesions</subject><subject>Female</subject><subject>Fetofetal Transfusion - surgery</subject><subject>Fetoscopy - adverse effects</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Humans</subject><subject>Hydrocephalus - epidemiology</subject><subject>Hydrocephalus - etiology</subject><subject>imaging</subject><subject>Infant, Newborn</subject><subject>Infant, Premature</subject><subject>Intracranial Hemorrhages - epidemiology</subject><subject>Intracranial Hemorrhages - etiology</subject><subject>Laser Therapy - adverse effects</subject><subject>Leukomalacia, Periventricular - epidemiology</subject><subject>Leukomalacia, Periventricular - etiology</subject><subject>Medical sciences</subject><subject>neurological</subject><subject>Obstetrics and Gynecology</subject><subject>outcome</subject><subject>Pregnancy</subject><subject>Prevalence</subject><subject>Risk Factors</subject><subject>twin-twin transfusion syndrome</subject><issn>0002-9378</issn><issn>1097-6868</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><recordid>eNp9kluLFDEQhRtR3HX1D_ggeRF86TG3zqRBFmTxBgsK6nNIJ5Uxsz3JmuoemX9vmhnXy4MvFULOqTrUl6Z5yuiKUaZebld2mzcrThlfUbWigt1rzhnt163SSt9vzimlvO3FWp81jxC3y5X3_GFzxgXlTPX6vCmfCuztCMkBscmTEvGGBOumXJDkQBwUGIodyQgYc0ISE0mQk50AiQ0TFDJarBXnsoFyICEXMv2IqV0KmYpNGObFSvCQfMk7eNw8CHZEeHI6L5qvb998uXrfXn989-Hq9XXrOkmnVgbQnusu1NBs6AfBtFASunVQwtqu54MXmgU_yM5T6Wytayel9cF3HQ2duGguj31v52EH3kGqaUZzW-LOloPJNpq_X1L8ZjZ5b4RUXLC-NnhxalDy9xlwMruIDsbR1g3MaBjVTK87pmSV8qPUlYxYINyNYdQssMzWLLDMAstQZSqsanr2Z8A7yy86VfD8JLDo7BjqMl3E3zolZd_rZfqrow7qOvcRikEXF6Q-FnCT8Tn-P8flP3Y3xhTrxBs4AG7zXFIFZZjB6jGfl3-0_CrGKa0RtPgJ_77K9w</recordid><startdate>20121001</startdate><enddate>20121001</enddate><creator>Vanderbilt, Douglas L., MD</creator><creator>Schrager, Sheree M., PhD</creator><creator>Llanes, Arlyn, RN</creator><creator>Chmait, Ramen H., MD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20121001</creationdate><title>Prevalence and risk factors of cerebral lesions in neonates after laser surgery for twin-twin transfusion syndrome</title><author>Vanderbilt, Douglas L., MD ; Schrager, Sheree M., PhD ; Llanes, Arlyn, RN ; Chmait, Ramen H., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c540t-4fe8d285f0221b9b318364e57f63aa592bd381fdb45d04ca5d07c44adfd550f53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Biological and medical sciences</topic><topic>cerebral lesions</topic><topic>Female</topic><topic>Fetofetal Transfusion - surgery</topic><topic>Fetoscopy - adverse effects</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Humans</topic><topic>Hydrocephalus - epidemiology</topic><topic>Hydrocephalus - etiology</topic><topic>imaging</topic><topic>Infant, Newborn</topic><topic>Infant, Premature</topic><topic>Intracranial Hemorrhages - epidemiology</topic><topic>Intracranial Hemorrhages - etiology</topic><topic>Laser Therapy - adverse effects</topic><topic>Leukomalacia, Periventricular - epidemiology</topic><topic>Leukomalacia, Periventricular - etiology</topic><topic>Medical sciences</topic><topic>neurological</topic><topic>Obstetrics and Gynecology</topic><topic>outcome</topic><topic>Pregnancy</topic><topic>Prevalence</topic><topic>Risk Factors</topic><topic>twin-twin transfusion syndrome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vanderbilt, Douglas L., MD</creatorcontrib><creatorcontrib>Schrager, Sheree M., PhD</creatorcontrib><creatorcontrib>Llanes, Arlyn, RN</creatorcontrib><creatorcontrib>Chmait, Ramen H., MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of obstetrics and gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vanderbilt, Douglas L., MD</au><au>Schrager, Sheree M., PhD</au><au>Llanes, Arlyn, RN</au><au>Chmait, Ramen H., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevalence and risk factors of cerebral lesions in neonates after laser surgery for twin-twin transfusion syndrome</atitle><jtitle>American journal of obstetrics and gynecology</jtitle><addtitle>Am J Obstet Gynecol</addtitle><date>2012-10-01</date><risdate>2012</risdate><volume>207</volume><issue>4</issue><spage>320.e1</spage><epage>320.e6</epage><pages>320.e1-320.e6</pages><issn>0002-9378</issn><eissn>1097-6868</eissn><coden>AJOGAH</coden><abstract>Objective To identify risk factors for cerebral lesions among survivors of twin-twin transfusion syndrome treated with laser surgery. Study Design A multilevel regression analysis examined risk factors for neonatal cerebral lesions identified by imaging. Imaging was routine in “high-risk survivors,” defined as those delivered at &lt;32 weeks' gestation, and by clinical indications if born later. Severe lesions were defined as: intraventricular hemorrhage grade III-IV, cystic periventricular leukomalacia, ventriculomegaly and/or hydrocephalus, microcephaly, infarctions, porencephalic/Dandy-Walker cysts, or bilateral other cysts. Results For 262 consecutive laser-treated twin-twin transfusion syndrome patients, 18 neonates had severe lesions identified among 427 individual survivors (4.2%) and 242 “high-risk survivors” (7.4%). Forty-six newborns had any cerebral lesion, resulting in lesion rates of 10.8%-19.0%. Delivery &lt;32 weeks' (odds ratio, 4.95; P &lt; .001) and &lt;28 weeks' (odds ratio, 6.25; P &lt; .001) gestation were associated with increased likelihood of any cerebral lesion. Conclusion This cohort showed low rates (4-7%) of severe neonatal cerebral lesions, with prematurity being the primary risk factor.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>23021698</pmid><doi>10.1016/j.ajog.2012.06.031</doi><tpages>2</tpages><oa>free_for_read</oa></addata></record>
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identifier ISSN: 0002-9378
ispartof American journal of obstetrics and gynecology, 2012-10, Vol.207 (4), p.320.e1-320.e6
issn 0002-9378
1097-6868
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source ScienceDirect Journals
subjects Biological and medical sciences
cerebral lesions
Female
Fetofetal Transfusion - surgery
Fetoscopy - adverse effects
Gynecology. Andrology. Obstetrics
Humans
Hydrocephalus - epidemiology
Hydrocephalus - etiology
imaging
Infant, Newborn
Infant, Premature
Intracranial Hemorrhages - epidemiology
Intracranial Hemorrhages - etiology
Laser Therapy - adverse effects
Leukomalacia, Periventricular - epidemiology
Leukomalacia, Periventricular - etiology
Medical sciences
neurological
Obstetrics and Gynecology
outcome
Pregnancy
Prevalence
Risk Factors
twin-twin transfusion syndrome
title Prevalence and risk factors of cerebral lesions in neonates after laser surgery for twin-twin transfusion syndrome
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