Optimisation of Examination of Children After Fetofetal Transfusion Syndrome
Study Objective: to optimise early examination of children born in monochorionic diamniotic twins depending on whether they had fetofetal transfusion syndrome (FFTS) or not. Study Design: comparative prospective cohort observation. Materials and Methods. We observed 60 premature children born in monochorionic diamniotic twins, with 26 weeks 0-6 days - 32 weeks 0-6 days of gestation. The study group (group I) included 30 post-FFTS children who antenatal surgical correction. Controls (group II) were 30 children who did not have FFTS. Intermediate checkpoints were follow-up (prospective) observation: checkpoint 1 - birth (26 weeks 0-6 days - 32 weeks 0-6 days); checkpoint 2 - 6 months of corrected age; checkpoint 3 - 12 months of corrected age; checkpoint 4 - 18 months of corrected age. All children underwent diffusion tensor MRI with tractography. Primary outcomes of the combined perinatal pathology in both cohorts were the incidence of severe organic central nervous disorders and moderate residual (functional) pathologies. Study Results. MRI with tractography demonstrated that the study parameters in group I and II at 6 months (corrected age) did not differ significantly, except for the average diffusion coefficient (ADC) of the right posterior limb of internal capsule. At the age of 12 months, post-FFTS infants demonstrated significant reduction in FA in the middle third of the body of corpus callosum (р = 0.034) and right splenium (р = 0.001), increased ADC in the right splenium (р = 0.0001). We have identified a trend to increased FA in the study group (internal capsule parameters); significantly higher FA was recorded in the right genu of internal capsule (р = 0.0001). At 18 months (corrected age), FA in the middle third of the body of corpus callosum in post-FFTS patients was significantly lower than in controls. ADC of the right posterior limb and genu of internal capsule, and the middle third of the body of corpus callosum were significantly higher in group I vs. group II. The structure of perinatal pathology outcomes in 18-month-old patients (corrected age): severe organic CNS pathology in group I was recorded more frequently - 14 (46.7) vs. 5 (16.7%) in group II (р < 0.05); moderate residual signs of perinatal CNS pathology were seen in 15 (50.0%) of controls vs. 13 (43.3%) of infants in the study group (р > 0.05); relatively healthy were 10 (33.3%) of patients in group II and only 3 (10.0%) babies in group I (р < 0.05). Conclusion. Post-FFTS children born in monochorionic diamniotic twins are at risk of defective pathway myelination rates at the age of 18 months (corrected age). The prognostic value of FFTS and defective rate of pathways maturity in corticospinal tract and posterior thalamic radiations was identified; the significance of dynamic control of pathway myelination rates in the brain of children at risk was proven