Blood pressure evaluation in children treated with laser surgery for twin-twin transfusion syndrome at 2-year follow-up

Objective Twin survivors of twin-twin transfusion syndrome (TTTS) may be at risk for early onset of cardiovascular disease. The aim of this study was to determine prevalence and risk factors for elevated blood pressure (BP) among children treated with selective laser photocoagulation of communicatin...

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Bibliographic Details
Published in:American journal of obstetrics and gynecology 2015-09, Vol.213 (3), p.417.e1-417.e7
Main Authors: Pruetz, Jay D., MD, Schrager, Sheree M., PhD, MS, Wang, Tiffany V., MS, Llanes, Arlyn, RN, BSN, Chmait, Ramen H., MD, Vanderbilt, Douglas L., MD
Format: Article
Language:English
Subjects:
cardiovascular disease
Child, Preschool
elevated blood pressure
Female
fetal interventions
fetal physiology
Fetal Therapies
Fetofetal Transfusion - complications
Fetofetal Transfusion - surgery
Follow-Up Studies
Humans
Hypertension - diagnosis
Hypertension - epidemiology
Hypertension - etiology
Laser Coagulation
Linear Models
Logistic Models
Male
Multivariate Analysis
Obstetrics and Gynecology
Postoperative Complications - diagnosis
Postoperative Complications - epidemiology
Pregnancy
Prevalence
Prospective Studies
Risk Factors
twin-twin transfusion syndrome
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Summary:Objective Twin survivors of twin-twin transfusion syndrome (TTTS) may be at risk for early onset of cardiovascular disease. The aim of this study was to determine prevalence and risk factors for elevated blood pressure (BP) among children treated with selective laser photocoagulation of communicating vessels. Study Design Data were prospectively collected from surviving children treated for TTTS with laser surgery from 2008 through 2010. Systolic BP (SBP) and diastolic BP (DBP) were obtained from 91 child survivors at age 24 months (±6 weeks) and evaluated based on age, sex, and height percentile. BP percentiles were calculated for each patient and categorized as normal (95%). Clinical variables were evaluated using multilevel regression models to evaluate risk factors for elevated BP. Results BP was categorized as normal in 38% and abnormal in 62% of twin survivors based on percentile for sex, age, and height; a comparable distribution was found for DBP elevation. There were no differences between donor and recipient twins for absolute SBP and DBP or BP classification. In a multivariate analysis, significant risk factors for higher SBP included prematurity (β –0.54; 95% confidence interval [CI], –0.99 to –0.09; P  = .02), higher weight percentile (β 0.24; 95% CI, 0.05–0.42; P  = .01), and presence of cardiac disease (β 0.50; 95% CI, 0.10–0.89; P  = .01). Prematurity was also a significant risk for abnormal DBP (odds ratio, 0.89; 95% CI, 0.80–1.00; P  = .05). Conclusion Child survivors of TTTS had elevated SBP and DBP measurements at 2 years of age, with no differences seen between former donor and recipient twins. Prematurity may be a risk factor for elevated BP measurements in this population. Future studies are warranted to ascertain whether these cardiovascular findings persist over time.
ISSN:0002-9378
1097-6868
DOI:10.1016/j.ajog.2015.05.031