NEURODEVELOPMENTAL OUTCOME FOR TWINS OF THE ESPRiT STUDY: THE NOTES STUDY
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Halling, Cecilie, NEURODEVELOPMENTAL OUTCOME FOR TWINS OF THE ESPRiT STUDY: THE NOTES STUDY, Trinity College Dublin.School of Medicine, 2021Download Item:
Abstract:
THE NOTES STUDY: ABSTRACT
Objective: The objective of the NOTES Study was to study the effect of birthweight growth discordance (≥ 20%) on neurodevelopmental outcome and physical growth of monochorionic and dichorionic twins and to compare the relative effects of fetal growth discordance and prematurity on cognitive outcome.
The NOTES Study also assessed the reliability of the ASQ-3 at identifying children with potential neurodevelopmental impairment.
Methods: We performed a cross-sectional multicentre prospective follow-up study. From a cohort of nearly 1,000 pairs of twins, 150 pairs of growth-discordant twins were identified. The entire twin cohort was assessed with the ASQ-3 questionnaire. A control group of twins was randomly selected from the concordant pairs and matched for gestation with the growth discordant group. These 2 groups were assessed with The Bayley Scales Assessment, 3rd Edition, from 24 months.
Sensitivity, specificity, and the total agreement between the ASQ-3 and the Bayley Scales were calculated.
To account for correlations within twin pairs, paired t-tests were used for inter-twin comparisons while a linear mixed effects model (with twin pair as a random effect to account for inter-twin correlations) was used for multiple regression analysis of developmental outcomes.
Results: A total of 1,298 out of a possible 1,921 (68%) completed the ASQ-3. One hundred nineteen growth discordant twins (79%) and 111 control pairs were recruited. The sensitivity of the ASQ-3 was 91% and the specificity was 86%. The total agreement between the ASQ-3 and the Bayley Scales was 87%.
Compared to the larger twin, the smaller twin in the growth-discordant group performed significantly worse in cognition, language, and motor skills (p-values 0.02). The smaller twin was also significantly shorter and lighter at 2 to 3 years of age (p-value<0.001).
Prematurity played a far more significant role on cognitive outcome than growth discordance did on those twins <33 weeks (mean composite cognitive score of 96.7 in infants ≤32 weeks vs 102.5 in those >32 weeks, difference of 5.8, p-value 0.008). By 33 weeks, both growth discordance and prematurity had a significant impact on cognitive outcome, while by 34 weeks only the effect of growth discordance remained significant.
Conclusions: The ASQ-3 can safely be used as a screening tool to identify those children at risk for developmental delay in a low-risk Irish population.
Growth discordance of 20% or more puts the smaller twin at a disadvantage in terms of neurodevelopment and physical growth at 2 to 3 years of age.
In the absence of other complications, growth discordance alone does not justify delivery prior to 33 weeks’ gestation as the effect of prematurity has a far more negative impact on cognition at this early gestation.
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National Children's Research Centre
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https://tcdlocalportal.tcd.ie/pls/EnterApex/f?p=800:71:0::::P71_USERNAME:HALLINGCDescription:
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Author: Halling, Cecilie
Advisor:
Corcoran, DavidPublisher:
Trinity College Dublin. School of Medicine. Discipline of Clinical MedicineType of material:
ThesisCollections
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Neuro-Development, Growth Discordant TwinsMetadata
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