Article Text

Download PDFPDF
Behavioural outcome in twin–twin transfusion syndrome survivors treated with laser surgery
  1. Fieke L Brandsma1,
  2. Marjolijn S Spruijt1,
  3. Monique Rijken1,
  4. Ratna N G B Tan2,
  5. Dick Oepkes3,
  6. Enrico Lopriore2,
  7. Jeanine M M van Klink1
  1. 1 Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
  2. 2 Neonatology, Leiden University Medical Centre, Leiden, The Netherlands
  3. 3 Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Dr Jeanine M M van Klink, Pediatrics, Leids Universitair Medisch Centrum, Leiden 2300 RC, The Netherlands; j.m.m.van_klink{at}


Objective Evaluate the incidence of and risk factors for behavioural problems in twin–twin transfusion syndrome (TTTS) survivors treated with fetoscopic laser coagulation.

Design Observational cohort study.

Setting National referral center for fetal therapy, Leiden University Medical Center, The Netherlands.

Patients Behavioural outcome was assessed in 417 TTTS survivors, at the age of 2 years.

Interventions Parents completed the Child Behavior Checklist for their twins. Antenatal, neonatal and follow-up data including Bayley III and a neurological exam were recorded from the medical database.

Main outcome measures The incidence of and risk factors for behavioural problems.

Results 332 twin pregnancies (664 fetuses) were treated with fetoscopic laser for TTTS between 2008 and 2015. For 517 children eligible for follow-up, 417 (81%) Child Behavior Checklist questionnaires were completed. The study group was born at a mean gestational age of 32.8 weeks±3.2. Total behavioural problems within the borderline to clinical range were reported in 8% (95% CI 5.9 to 11.2) of survivors, compared with 10% in the general Dutch population (p=0.12). No difference between donors and recipients was detected (p=0.84). Internalising and externalising problems were reported in 9.4% (95% CI 6.9 to 12.6) and 11.5% (95% CI 8.8 to 15.0), respectively. Severe neurodevelopmental impairment was more frequent in the children with behavioural problems. High maternal educational level was associated with lower behavioural problem scores.

Conclusion Parents of twins treated with fetoscopic laser therapy for TTTS do not report more behavioural problems compared with general population norms. More behavioural problems are reported in children with severe neurodevelopmental impairment.

  • twin studies
  • twin twin transfusion syndrome
  • behavior
  • neurodevelopment
  • fetal medicine

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors JvK and EL made substantial contributions to the conception and design of the work; JvK and FLB made substantial contributions the acquisition, analysis and all authors (FLB, MSS, MR, RNGBT, DO, EL and JvK) made substantial contributions to the interpretation of data for the work; JvK and FLB drafted the work and all authors (FLB, MSS, MR, RNGBT, DO, EL and JvK) revised it critically for important intellectual content; all authors (FLB, MSS, MR, RNGBT, DO, EL and JvK) approved the final version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The follow-up study was approved by the Institutional Review Board of the LUMC (Protocol number/ID 30878/8226).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.