Neurodevelopmental outcome of monochorionic twins with selective intrauterine growth restriction (SIUGR) type II: laser versus expectant management

Figures & data

Figure 1. Source of patient population.

Table 1. Antenatal demographics.

Demographics	Expectant management (N = 6)	Laser (N = 14)	p Value
Gestational age at diagnosis (weeks)	21.5 + 2.0 21.9 (18.4–23.6)	21.1 + 2.8 21.0 (17.1–26.4)	.7414
Gestational age at delivery (weeks)	28.3 + 1.8 27.6 (26.7–31.3)	33.4 + 3.8 33.2 (28.3–40.0)	.0039
Birthweight AGA (grams)	1053 + 449 1035 (402–1785)	2236 + 917 2208 (1070–3765)	.0083
Birthweight IUGR (grams)	N = 6 589 + 346 515 (226–1231)	N = 4 864 + 255 828 (605–1195)	.1356

AGA: appropriate for gestational age twin; IUGR: growth-restricted twin.

Table 2. Indication for delivery.

Indication for delivery	Expectant [6]	Laser [14]
Elective	0	4
AREDV	2	1
Nonreassuring fetal testing	3	2
PPROM	1	2
PTL	0	5

AREDV: absent – reverse end-diastolic velocity in the umbilical artery; PPROM: preterm premature rupture of membranes; PTL: preterm labor.

Table 3. Perinatal outcome.

Perinatal outcome	Expectant management (N = 6)	Laser (N = 14)	p Value
IUFD AGA	0	0	NA
IUFD IUGR	0	10 (71.4)	.0108
Survival of at least one twin	6 (100%)	14 (100%)	NA
AGA alive 30 days	6 (100%)	14 (100%)	NA
AGA alive 6 months	6 (100%)	14 (100%)	NA
IUGR alive 30 days	4 (66.7%)	4 (28.6%)	.1611
IUGR alive 6 months	3 (50.0%)	4 (28.6%)	.6126

IUFD: fetal demise; AGA: appropriately grown twin; IUGR: growth-restricted twin.

Table 4. Gross neurological outcome.

Neurological outcome	Expectant management (N = 6)	Laser (N = 14)	p Value
AGA grade III–IV IVH	2 (33.3%)	0	.0789
IUGR grade III–IV IVH	N = 4 1 (25.0%)	N = 4 0	1.0000
AGA cerebral palsy	0 (0%)	1 (7.1%)	1.0000
IUGR cerebral palsy	N = 3 1 (33.3%)	N = 4 0	.4286
NDI AGA	N = 5 0	N = 12 1 (8.3%)	1.0000
NDI IUGR	N = 2 1 (50%)	N = 4 0	.33

AGA: appropriate for gestational age twin; IUGR: growth-restricted twin; IVH: intraventricular hemorrhage; NDI: neurodevelopmental impairment defined as cerebral palsy, Battelle Developmental Inventory-2 (BDI-2) score less than 70, blindness, and/or deafness.

Figure 2. Motor developmental quotient in the IUGR children. There was a tendency for lower scores in the expectantly managed group (p=.062). IUGR: growth restricted twin.

Table 5. Neurodevelopmental outcomes: AGA baby.

Battelle standardized scores AGA twin	Expectant management (N = 5)	Laser (N = 12)	p Value
Total	100.0 + 32.8 87.0 (67.0–143.0)	98.4 + 49.4 91.5 (70.0–185.0)	.9161
Adaptive domain	40.8 + 15.2 45.0 (14.0–50.0)	38.8 + 26.7 34.5 (0.0–93.0)	.6723
Cognitive domain	34.2 + 32.3 27.0 (5.0–82.0)	46.8 + 33.9 55.5 (0.0–93.0)	.4927
Communication domain	62.2 + 22.1 55.0 (34.0–92.0)	55 + 30.9 50.0 (0.0–92.0)	.7110
Motor domain	11.0 + 7.0 8.0 (5.0–19.0)	39.5 + 34.1 43.5 (0.0–91.0)	.2910
Personal social domain	66.2 + 34.1 75.0 (10.0–99.0)	50.3 + 29.5 75.0 (0–94)	.7612

AGA: appropriately grown twin.

Table 6. Neurodevelopmental outcomes: IUGR baby.

Battelle standardized scores IUGR twin	Expectant management (N = 2)	Laser (N = 4)	p Value
Total	72.0 + 31.1 72.0 (50.0–94.0)	92.8 + 22.1 88.5 (71.0–123.0)	.64
Adaptive domain	19.6 + 27.5 19.6 (0.1–39.0)	38.0 + 38.0 25.5 (9.0–92.0)	.64
Cognitive domain	19.6 + 27.5 19.6 (0.1–39.0)	38.9 + 31.8 33.0 (0.5–77.0)	.48
Communication domain	22.6 + 31.7 22.6 (0.1–45.0)	39.8 + 38.4 32.5 (7.0–87.0)	.35
Motor domain	1.05 + 1.34 1.05 (0.10–2.00)	29.8 + 27.9 23.0 (5.0–68.0)	.06
Personal social domain	41.1 + 57.9 41.1 (0.10–82.0)	45.0 + 38.8 33.0 (16.0–98.0)	.63

IUGR: growth-restricted twin.

Table 7. Total developmental quotient AGA versus IUGR in paired children.

AGA	IUGR	N	Group	p^a
99.67	85.83	6	Overall	.024
89	72	2	EM	.416
105	92.75	4	LT	.053

AGA: appropriately grown twin; IUGR: growth-restricted twin.

^aStudent’s t-test. EM: expectant management. LT: laser therapy.

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