Advanced Fetal Care Center (AFCC)

Evolution of Cerebral Development in Twin-Twin Transfusion Syndrome (TTTS)

Principle investigators:

• Tomo Tarui, MD, Clinical Fellow, Department of Neurology
• P. Ellen Grant, MD, Department of Radiology
   

In this study, conducted in collaboration with the Fetal-Neonatal Neuroimaging & Developmental Science Center, we aim to study the evolution of brain injury in babies and its effect on normal brain development while the baby is still in the mother's womb. We will study how a fetal disease, Twin-Twin Transfusion Syndrome (TTTS), injures the fetal brain and impacts its further development.

TTTS is a disorder affecting identical twins from fetal life and has serious impacts on a baby's general health resulting in high rates of morbidity (30%). Babies surviving TTTS have a very high risk of abnormal neurological function (20%). This risk has not decreased despite improvements in obstetric and neonatal care in recent decades. Little is known about the evolution of fetal brain injury and its impact on fetal brain development. Care providers have limited means to prevent the injury on the fetal brain.

We will study the impact of TTTS on the developing fetal brain by implementing a novel imaging technique known as quantitative fetal MRI. This technology enables us to detect fetal brain injury in detail, allowing physicians to determine the appropriate timing and intervention for fetuses and newborns affected by TTTS. We will also study long-term neurodevelopmental outcomes of these babies and clarify the relationship of these outcomes to abnormal brain development and injury in fetal life. The findings from this study will provide an efficient monitoring tool of fetal brain development and injury. This will eventually enable physicians to provide useful information to improve long-term neurological health and function of babies affected by brain injury in the womb. This new approach has applications for other types of fetal brain injury, including the potential to detect and manage babies at risk of brain injury before they are born and improve their long-term developmental potential.