{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T12:08:20Z","timestamp":1785499700131,"version":"3.56.0"},"reference-count":31,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2019,8,15]],"date-time":"2019-08-15T00:00:00Z","timestamp":1565827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Despite many developments in its management, twin-to-twin transfusion syndrome (TTTS) remains an important risk factor for long-term neurodevelopmental impairment (NDI). Our objective was to compare the incidence of severe NDI in a recent cohort of TTTS survivors, treated with laser surgery from 2011 to 2014, with a previous cohort treated from 2008 to 2010. Neurological, cognitive, and motor development were assessed at two years of age. We determined risk factors associated with Bayley-III scores. Severe NDI occurred in 7\/241 (3%) survivors in the new cohort compared to 10\/169 (6%) in the previous cohort (p = 0.189). Disease-free survival (survival without severe impairment) did not significantly differ. Low birth weight and being small for gestational age (SGA) were independently associated with lower cognitive scores (both p &lt; 0.01). Severe cerebral injury was related to decreased motor scores (B = \u221214.10; 95% CI \u22123.16, \u221225.04; p = 0.012). Children with severe NDI were born \u226532 weeks\u2019 gestation in 53% of cases and had no evidence of cerebral injury on cranial ultrasound in 59% of cases. Our results suggest that improvement in outcome of TTTS has reached a plateau. Low birth weight, SGA, and cerebral injury are risk factors for poor neurodevelopmental outcome. Neither gestational age above 32 weeks nor the absence of cerebral injury preclude severe NDI.<\/jats:p>","DOI":"10.3390\/jcm8081226","type":"journal-article","created":{"date-parts":[[2019,8,15]],"date-time":"2019-08-15T11:11:00Z","timestamp":1565867460000},"page":"1226","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Long-Term Neurodevelopmental Outcome in Twin-to-Twin Transfusion Syndrome: Is there still Room for Improvement?"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8723-4755","authenticated-orcid":false,"given":"Marjolijn S.","family":"Spruijt","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, J7-48, Albinusdreef 2, 2333 ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Lopriore","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, J7-48, Albinusdreef 2, 2333 ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ratna N.G.B.","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, J7-48, Albinusdreef 2, 2333 ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Femke","family":"Slaghekke","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Division of Fetal Therapy, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frans J.C.M.","family":"Klumper","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Division of Fetal Therapy, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna M.","family":"Middeldorp","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Division of Fetal Therapy, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique C.","family":"Haak","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Division of Fetal Therapy, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dick","family":"Oepkes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Division of Fetal Therapy, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5598-7135","authenticated-orcid":false,"given":"Monique","family":"Rijken","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, J7-48, Albinusdreef 2, 2333 ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanine M.M.","family":"van Klink","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, J7-48, Albinusdreef 2, 2333 ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,8,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/S0143-4004(05)80201-2","article-title":"Placental surgery: A new frontier","volume":"14","author":"Kuhlmann","year":"1993","journal-title":"Placenta"},{"key":"ref_2","first-page":"595","article-title":"Effects of placental chorionicity on outcome in twin pregnancies. 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