This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Hypothesis: Follow up of survivors of severe twin-twin transfusion syndrome (TTTS) will determine whether survivors have improved neurodevelopmental outcome as a result of laser coagulation of common placental blood vessels compared to survivors who underwent the standard treatment of serial removals of amniotic fluid. Neurodevelopment is being assessed at 18-22 months of age, corrected for prematurity. The purpose of this neurodevelopmental follow up is to determine if survivors of severe TTTS have improved outcome if they received laser coagulation of common placental blood vessels compared to survivors who underwent the standard treatment of serial amnioreduction (removal of amniotic fluid). Neurodevelopment is being assessed at 18-22 months of age, corrected for prematurity. Experimental Design: This trial is a 5-yr multicenter prospective, randomized-controlled trial to examine the effect of selective fetoscopic laser photocoagulation compared to serial amnioreduction on perinatal mortality in severe TTTS. Patients meeting entry criteria and consenting to enter the trial will be randomized to one of the two treatment arms with equal likelihood. Patients will be seen in the Mary L Johnson Infant Development Clinic at Packard Children's Hospital at 18-22 months-corrected age. At that time they will undergo a standard neurodevelopmental assessment including Bayley Infant Scales of Human Development II, physical exam, neurosensory screening including vision and hearing, and medical and social histories will be colle
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