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. 2025 May;114(5):1022-1029.
doi: 10.1111/apa.17532. Epub 2024 Dec 9.

Amplitude-integrated electroencephalography showed alterations in cerebral activity in monochorionic twins with twin-to-twin transfusion syndrome

Christina Schreiner  1 , Anna Staudt  1 , Vera Neubauer  1 , Ursula Kiechl-Kohlendorfer  1 , Elke Griesmaier  1
Affiliations

Amplitude-integrated electroencephalography showed alterations in cerebral activity in monochorionic twins with twin-to-twin transfusion syndrome

Christina Schreiner et al. Acta Paediatr. 2025 May.

Abstract

Aim: Monochorionic twins are at higher risk of perinatal mortality and morbidity, primarily due to pregnancy-related complications, such as twin-to-twin transfusion syndrome (TTTS). We aimed to investigate whether amplitude-integrated electroencephalography (aEEG) signals are different between monochorionic twins with and without TTTS.

Methods: This was a retrospective single-centre study conducted at Innsbruck Medical University Hospital, Austria. Preterm infants born before 32 weeks of gestation between 6 November 2010 and 6 December 2022 were eligible. The aEEG was analysed for the total maturation score, its component scores and the number of sleep-wake cycles per hour.

Results: We enrolled 79 monochorionic twin infants (48% male) and 157 dichorionic (62% male) twin infants. We found no differences between these two groups of preterm infants regarding the total maturation and component scores, or the number of sleep wake cycles. Monochorionic twins with TTTS showed significantly lower total maturation scores and individual component scores compared to monochorionic twins without TTTS.

Conclusion: Preterm infants with TTTS showed differences in neonatal aEEG signals. Whether these differences are caused by prematurity-related or TTTS-related factors, such as hemodynamic and metabolic changes due to placental anastomoses, should be investigated in future prospective studies, to gain more insight into this important topic.

Keywords: amplitude‐integrated electroencephalography; monochorionic twin; preterm infant; preterm twin; twin‐to‐twin transfusion syndrome.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Total maturation score in monochorionic and dichorionic twins. The continuous line shows the median. Y‐axis shows the total maturation score. *p < 0.05. DC, dichorionic; MC, monochorionic.
FIGURE 2
FIGURE 2
Total maturation score in monochorionic twins with and without twin‐to‐twin transfusion syndrome (TTTS). The continuous line shows the median. Y‐axis shows the total maturation score. Upper and lower whisker are shown as lines. *p < 0.05, **p < 0.01, ***p < 0.001.
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