475 - Are Growth Restricted Monochorionic Twins At Higher Risk For Neurodevelopmental Impairment Compared With Larger Co-twins?

Poster Number: 475
Publication Number: 475.343

Gloria Brembilla, Buzzi Children Hospital , asst fbf sacco, Milan, Lombardia, Italy; Daniela Casati, Buzzi Children's Hospital, MILAN, Lombardia, Italy; Mariano M. Lanna, Ospedale dei Bambini V Buzzi, Milan, Lombardia, Italy; Irene Cetin, University of MIlano, Milano, Lombardia, Italy; Barbara scelsa, V.Buzzi Children's Hospital, Milan, Lombardia, Italy; Marina A. Balestriero, -CHILDREN'S HOSPITAL " VITTORE BUZZI ", Milano, Lombardia, Italy; Francesca Castoldi, NICU V.Buzzi Children's Hospital, Milan, Lombardia, Italy; Francesco Cavigioli, V.Buzzi Children's Hospital, milan, Lombardia, Italy; Gianluca Lista, V.Buzzi Children's Hospital ASST-FBF-Sacco, Milan, Lombardia, Italy

Background: Monochorionic (MC) twins pregnancies could be complicated by selective fetal growth restriction (sFGR) in 15% of cases. Single survivors suffers the 20% risk of neurological damage; less is reported on perinatal outcome of double survivors.

Objective: To assess neurological long term outcomes of MC twins with selective fetal growth restriction (sFGR).

Design/Methods: A prospective neurological evaluation of MC twins with sFGR born in our center is ongoing from 2013. sFGR are defined according to Delphi consensus and stratified with Gratacos classification based on Doppler velocimetry pattern of the umbilical artery of the smaller twin (pulsatility index above 95º type 1, absent or reversed end diastolic flow type 2, intermittent pattern type 3). Exclusion criteria: intrauterine fetal death of one twin, twin-to-twin transfusion syndrome, twin anemia polycythemia sequence, any known fetal malformation or genetic syndrome. All children were prematurely born by cesarean section. Sequential brain ultrasound and/or magnetic resonance imaging (MRI) at term, pediatric and neurological evaluations were performed. Neurodevelopmental test (Bayley scale) were obtained by a single examiner at 12 and 24 months corrected age. Outcomes are analyzed by paired t test for intra-twin pair differences and by chi square for categorical variables.

Results: We evaluated 25 MC pregnancies affected by sFGR with double survivors twins (17 type 1, 1 type 2 and 7 type 3). Mean weight difference was 25% (±6%). Perinatal characteristics and main long term neurological outcomes in table 1 according to twins’ growth. Cerebral MRI at term corrected age showed abnormalities in five children, all large twins: IVH grade 3 (1), perivenular lesion (1), PVL (2), cortical lesion (1). One large twin (30 wks GA), developed cerebral palsy. Neurodevelopmental scores were comparable between twins, except for language scores at 12 months that were lower for sFGR twins. A transient motor delay was more common among large co-twins, however with no statistically significant difference.Conclusion(s): sFGR in association with prematurity affects neurological outcome in double survivors MC twins. Although neurodevelopmental scores are in the normal range in the most of the children, larger twins seem to be at higher risk of cerebral MRI abnormalities and motor deficit. It can be speculated that hemodynamic changes induced by sFGR in MC pregnancies could damage brain development in both twins. Long term neurological follow up (at least up to 2/3 years old) is then recommended also for larger co-twins.
Neurological outcome in sFGR twins VS large twinssFGR, selective Fetal Growth Restriction; GA, Gestational Age; BW, Body Weight; MRI, Magnetic Resonance Imaging; SD, Standard Deviation