Background
The preferred treatment for twin-twin transfusion syndrome is fetoscopic laser coagulation
of inter-twin vascular anastomoses on the monochorionic placenta. Severe postoperative
complications can occur when inter-twin vascular anastomoses remain patent including
twin-anemia polycythemia sequence or recurrent twin-twin transfusion syndrome. To
minimize the occurrence of residual anastomoses, a modified laser surgery technique,
the Solomon technique, was developed in which the entire vascular equator is coagulated.
In the Solomon randomized controlled trial (NTR1245), the Solomon technique was associated
with a significant reduction in twin-anemia polycythemia sequence and recurrence of
twin-twin transfusion syndrome when compared with the standard laser surgery technique.
Although a significant improvement in perinatal outcome was shown after the Solomon
technique, the clinical importance should also be ascertained with long-term follow-up
evaluation of the surviving children.
Objective
The purpose of this study was to compare the long-term neurodevelopmental outcome
in surviving children with twin-twin transfusion syndrome who were included in the
Solomon randomized trial and treated with either the Solomon technique or standard
laser surgery technique.
Study Design
Routine standardized follow-up evaluation in survivors, at least 2 years after the
estimated date of delivery, was performed at 2 of the 5 centers that participated
in the Solomon trial: Buzzi Hospital Milan (Italy) and Leiden University Medical Center
(The Netherlands). The primary outcome of this follow-up study was survival without
long-term neurodevelopmental impairment at age 2 years. Neurodevelopmental impairment was defined as cerebral palsy, cognitive and/or motor development score of <85, bilateral
blindness, or deafness. Cognitive and motor development was evaluated with the use
of Bayley-III. All analyses per fetus, neonate, or child were conducted with the generalized
estimated equation module to account for the effect that observations between co-twins
are not independent.
Results
The primary outcome (survival without neurodevelopmental impairment) was detected
in 95 of 141 cases (67%) in the Solomon group and in 99 of 146 cases (68%) in the
standard group (P = .92). Neurodevelopmental impairment in long-term survivors who were included for
follow-up evaluation was detected in 12 of 107 cases (11%) in the Solomon and in 10
of 109 cases (9%) in the standard group (P = .61). Neurodevelopmental impairment was due to cerebral palsy in 1 case (1%; spastic
unilateral) in the Solomon group and in 2 cases (2%; spastic unilateral and spastic
bilateral) in the standard group (P = .58). Cognitive development <85 cases was detected in 2 of 105 children (2%) in
the Solomon group and in 6 of 106 children (6%) in the standard group (P = .23). Motor development <85 occurred in 8 of 103 children (8%) in the Solomon group
and 3 of 104 children (3%) in the standard group (P = .23).
Conclusion
We found no difference in survival without neurodevelopmental impairment between the
Solomon and standard laser techniques. In view of the reduction of short-term complications
and the absence of increased adverse long-term effects, these data support the use
of the Solomon technique in the treatment of twin-twin transfusion syndrome.
Key words
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Article info
Publication history
Published online: August 19, 2015
Accepted:
August 12,
2015
Received in revised form:
August 6,
2015
Received:
May 27,
2015
Footnotes
The authors report no conflict of interest.
Cite this article as: van Klink JMM, Slaghekke F, Balestriero MA, et al. Neurodevelopmental outcome at 2 years in twin-twin transfusion syndrome survivors randomized for the Solomon trial. Am J Obstet Gynecol 2016;214:113.e1-7.
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© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
