Universal Cranial Ultrasound Screening in Preterm Infants With Gestational Age 33-36 Weeks. A Retrospective Analysis of 724 Newborns

Abstract Background preterm neonates less than 37 weeks of gestational age are more liable to hemorrhagic and ischemic brain lesions due to the immaturity of capillary bed, cerebral auto-regulation and vascular anastomosis, with consequent adverse outcome, poor cognitive development, and cerebral palsy. Cranial ultrasound is a safe imaging modality with no need to radiation exposure or sedation. Aim of the Work to evaluate the usefulness of universal cranial ultrasound screening in preterm neonates in the neonatal ICU with gestational age between 28 and 37 weeks to detect the different intra cranial pathologies in this pediatric group. Patients and Methods After taking approval by the Radiology Department Committee of the Faculty of Medicine, Ain shams University, the current study was performed on all preterm neonates (50) admitted to neonatal ICU in Ain shams hospital between 28 and 37 weeks of gestational age, between the third and seventh day of life, from July 1, 2017 to April 1, 2018 were included in the study. Results The study showed normal transcrainal ultrasound (72.0%), Germinal matrix hemorrhage (10.0%), Intraventricular hemorrhage (6.0%), Periventricular leukomalacia (6.0%), Congenital anomalies is Dandy walker malformation (2.0%), Chiari malformation (0.0%), Agenesis of corpus callosum (2.0%) and Porencephalic cyst (2.0%) of finding of ultrasound. Conclusion The importance of preterm screening by cranial ultrasound is sustained by the observation that most preterm neonates with abnormal CUS are usually asymptomatic. Only occasionally these patients develop symptoms.Linear high frequency probe of ultrasound was of great benefit in better visualization of anatomical details and mild pathological lesions.

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CRANIAL ULTRASOUND: EFFICIENT SCREENING TOOL FOR EARLY DETECTION OF BRAIN INJURY IN PRETERM INFANTS

MNJ (Malang Neurology Journal) ◽

10.21776/ub.mnj.2021.007.01.2 ◽

2021 ◽

Vol 7 (1) ◽

pp. 7-11

Author(s):

Dini Rachma Erawati ◽

Yuyun Yueniwati

Keyword(s):

Brain Injury ◽

Early Detection ◽

Preterm Infants ◽

Gestational Age ◽

Screening Tool ◽

Mode Of Delivery ◽

Fisher Exact Test ◽

Cranial Ultrasound ◽

Cross Sectional ◽

Ultrasound Findings

Background: Cranial ultrasound becomes an important diagnostic tool to evaluate brain injury in infants. Brain injury is a major complication for preterm birth. The brain injury of preterm infants differs from that of a term infant. Brain injury has correlation with gestational age and mode of delivery. Objective: To analyze the correlation between cranial ultrasound findings with gestational age and mode of delivery and to reveal if cranial ultrasound can be used to detect brain injury in premature infants. Methods: An observational analytic study using cross-sectional design took place in Saiful Anwar Hospital Malang, Indonesia. 38 healthy preterm infants underwent cranial ultrasound examination within the first four day of life. Fisher Exact test was used to analyze the correlation between cranial ultrasound findings with gestational age and mode of delivery. Results: Most of the healthy preterm infants (89.5%) were ≥ 32 weeks gestational age, and 52.6% of samples had caesarean section as their mode of delivery. There were three abnormal findings in cranial ultrasound; increased periventricular echogenic (5.3%), increased parenchym echogenic (5.3%), and indistinguishable of gray-white matter differentiation (5.3%). There was no significant correlation between abnormal cranial ultrasound findings with gestational age and mode of delivery (p= 0.202; p= 0.218). Conclusion: There were abnormal cranial ultrasound findings in some healthy preterm infants despite no significant correlation between ultrasound findings with gestational age and mode of delivery. Cranial ultrasound in preterm infants could become a screening tool for early detection of brain injury.

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Predictors of Long-Term Outcome in Very Preterm Infants: Gestational Age Versus Neonatal Cranial Ultrasound

PEDIATRICS ◽

10.1542/peds.112.5.1108 ◽

2003 ◽

Vol 112 (5) ◽

pp. 1108-1114 ◽

Cited By ~ 49

Author(s):

B. Vollmer ◽

S. Roth ◽

J. Baudin ◽

A. L. Stewart ◽

B. G. R. Neville ◽

...

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Cranial Ultrasound ◽

Term Outcome ◽

Long Term Outcome ◽

Very Preterm Infants ◽

Very Preterm

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Brain GRowth Evaluation Assessed with Transfontanellar (B-GREAT) ultrasound. Old and new bedside markers to estimate cerebral growth in preterm infants: a pilot study

American Journal of Perinatology ◽

10.1055/a-1704-1716 ◽

2021 ◽

Author(s):

Roberta Arena ◽

Francesca Gallini ◽

Domenico Umberto De Rose ◽

Francesca Conte ◽

Luca Giraldi ◽

...

Keyword(s):

Corpus Callosum ◽

Preterm Infants ◽

Gestational Age ◽

Intraclass Correlation ◽

Growth Curves ◽

Brain Structures ◽

Preterm Neonates ◽

Cranial Ultrasound ◽

Brain Growth ◽

Growth Evaluation

Objective: We aimed to investigate the feasibility of evaluating overall preterm brain growth using a gathered set of measurements of brain structures in standard cranial ultrasound planes. We called this method of assessment Brain GRowth Evaluation Assessed with Transfontanellar ultrasound (B-GREAT). Study design: In this prospective observational cohort study, cranial ultrasound was regularly performed (on day 1, 2, 3, 7 of life and then weekly until discharge and at term) in preterm infants born with a gestational age less than 32 weeks. We evaluated Corpus Callosum (CC) length, Corpus Callosum-Fastigium (CCF) length, Anterior Horn Width (AHW), Frontal White Matter (FWM) height, Total brain Surface (TBS), Deep Grey Matter (DGM) height, Hemisphere Height (HH), Transverse Cerebellar Diameter in the axial view (TCDax) and coronal view (TCDcor). Measurements obtained were used to develop growth charts for B-GREAT markers as a function of postmenstrual age. Reproducibility of B-GREAT markers was studied. Results: A total of 528 cranial ultrasounds was performed in 80 neonates (median birth gestational age: 28+5 weeks, interquartile range: 27+3 to 30+5). The intraclass correlation coefficients for intra-observer and inter-observer analyses showed substantial agreement for all B-GREAT markers. Growth curves for B-GREAT markers were developed. Conclusion: B-GREAT is a feasible and reproducible method for bedside monitoring of the growth of the main brain structures in preterm neonates.

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Cranial ultrasound screening in late preterm infants

Italian Journal of Pediatrics ◽

10.1186/1824-7288-40-s2-a20 ◽

2014 ◽

Vol 40 (S2) ◽

Author(s):

M Fumagalli ◽

LA Ramenghi ◽

A De Carli ◽

L Bassi ◽

F Dessimone ◽

...

Keyword(s):

Preterm Infants ◽

Late Preterm ◽

Cranial Ultrasound ◽

Ultrasound Screening ◽

Late Preterm Infants

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Incidence and Severity of Intra-Ventricular Hemorrhage (IVH) in Preterm Infants, Northeast of Iran

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v36i1.14457 ◽

2016 ◽

Vol 36 (1) ◽

pp. 38-41

Author(s):

Mahnaz Fouladinejad ◽

Hadi Khorsand zak ◽

Nematollah Nematollahi ◽

Ehsan Alaee

Keyword(s):

Birth Weight ◽

Preterm Infants ◽

Gestational Age ◽

Very Low Birth Weight ◽

Cross Sectional Study ◽

Cranial Ultrasound ◽

Academic Hospital ◽

Cross Sectional ◽

Portable Ultrasound ◽

Ventricular Hemorrhage

Introduction: The incidence rate of Intra-Ventricular Haemorrhage (IVH) varies from 20% to 25% among preterm infants with a very low birth weight. IVH could compose critical disabilities which are directly associated to its grade. The aim of this study was to evaluate the incidence and severity of IVH in preterm infants referred to the academic Hospital of Gorgan, Northeast of Iran.Materials and Methods: In this cross-sectional study, we examined all preterm infants who had been referred to the academic Hospital of Gorgan, Northeast of Iran between Augusts 2014 and February 2015. Seventy one preterm infants (≤34 weeks of gestation, ≤1500g birth weight) have been included. Cranial ultrasound was done within 3-5 days of birth for all subjects and subsequent ultrasounds were performed based on their birth weight by portable ultrasound device.Results: The overall incidence of IVH was 64.8% in the present study. There was a significant relationship between IVH incidence and the gestational age (p=0.010). Also the lower birth weight was associated to the higher rate of IVH complications reported in sequential ultrasounds (p<0.05).Conclusion: Gestational age and birth weight seem to have key roles in the occurrence and severity of IVH, respectively.J Nepal Paediatr Soc 2016;36(1):38-41

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Bilateral Cystic Periventricular Leukomalacia in the Premature Infant: Associated Risk Factors

PEDIATRICS ◽

10.1542/peds.97.6.822 ◽

1996 ◽

Vol 97 (6) ◽

pp. 822-827 ◽

Cited By ~ 5

Author(s):

Jeffrey M. Perlman ◽

Rick Risser ◽

R. Sue Broyles

Keyword(s):

Positive Predictive Value ◽

Premature Infant ◽

Preterm Infants ◽

Predictive Value ◽

Intraventricular Hemorrhage ◽

Periventricular Leukomalacia ◽

Univariate Analysis ◽

Cranial Ultrasound ◽

Ultrasound Screening ◽

Increased Risk

Background. Bilateral cystic periventricular leukomalacia (PVL) is a major cause of neurodevelopmental delay in the premature infant. Thus, early identification of the preterm infant at highest risk for the subsequent development of this lesion is critical. Objectives. The three objectives of this case-control study were: (1) to determine the basic characteristics of cystic PVL, (2) to assess the relationship of perinatal clinical events and PVL, and (3) to ascertain the feasibility of identifying early those preterm infants at highest risk for the development of PVL. Methods. The medical records and cranial ultrasound scans (HUSs) were reviewed for 632 infants weighing less than 1750 g who were admitted to the neonatal intensive care unit between January 1992 and December 1993. PVL developed in 14 infants of 1285 ± 301 g birth weight (BW) and 29.4 ± 1.5 weeks' gestational age (GA); severe intraventricular hemorrhage (n = 21) and intraparenchymal echodensity (n = 12) developed in 33 infants of 904 ± 248 g BW and 26.6 ± 1.8 weeks' GA; and 585 infants of 1315 ± 324 g BW and 29.7 ± 2.4 weeks' GA with normal HUS findings (n = 473) or grade I or II intraventricular hemorrhage (n = 112) served as a comparison group. Results. Cystic PVL was observed in 14 (2.3%) of 632 infants weighing less than 1750 g, more specifically, in 3.2% of infants weighing less than 1500 g. Cysts were noted from the 7th to 14th days of life in 10 infants and from the 20th to 46th days of life in 4 infants. Ten (70%) of the infants had relatively benign clinical courses, and most cases were detected by routine HUS surveillance. Overt hypotension in the immediate perinatal period was noted in 3 (21%) infants; late hypotension developed in 1 additional infant. Univariate analysis indicate that two clinical indicators, prolonged rupture of membranes (PROM) and chorioamnionitis, were significant predictors of PVL. For PROM, the odds ratio estimate and the 95% confidence limit are 6.59 and 1.96 to 22.10, with a sensitivity of 28.6% and positive predictive value of 11.5%. Similar values for chorioamnionitis are 6.77 (1.77 to 25.93), with a sensitivity of 21.4% and positive predictive value of 11.5%. Conclusions. (1) Most cases of symmetric cystic PVL occurred in infants with relatively benign clinical courses and were only detected by routine ultrasound screening. (2) Postnatal systemic hypotension seems to be an uncommon associated event. (3) Preterm infants born to mothers with PROM and/or chorioamnionitis seem to be at an increased risk for the development of PVL and should be carefully evaluated.

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Lenticulostriate Vasculopathy in Very-Low-Birth-Weight Preterm Infants: A Longitudinal Cohort Study

Children ◽

10.3390/children8121166 ◽

2021 ◽

Vol 8 (12) ◽

pp. 1166

Author(s):

Yi-Li Hung ◽

Chung-Min Shen ◽

Kun-Long Hung ◽

Wu-Shiun Hsieh

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Preterm Infants ◽

Gestational Age ◽

Very Low Birth Weight ◽

Late Onset ◽

Cranial Ultrasound ◽

Linear Type ◽

Vlbw Infants ◽

Lenticulostriate Vasculopathy

Background: The pathogenesis and clinical significance of lenticulostriate vasculopathy (LSV) are unclear. Our study aimed to determine the prevalence, presentation, and evolution of LSV, and the perinatal risk factors associated with LSV among very-low-birth-weight (VLBW) preterm infants. Methods: One-hundred-and-thirty VLBW preterm infants were retrospectively enrolled in this study. Serial cranial ultrasound examinations were performed regularly from birth until a corrected age of 1 year. Infants with LSV were assigned to early-onset (≤10 postnatal days) and late-onset (>10 postnatal days) groups. Data describing the infants’ perinatal characteristics, placental histopathology, and neonatal morbidities were collected, and the groups were compared. Results: Of the VLBW infants, 39.2% had LSV before they were 1 year old. Linear-type LSV was the most common presentation, and >50% of the infants had bilateral involvement. LSV was first detected at 112 ± 83 postnatal days, and its detection timing correlated negatively with gestational age (GA) (R2 = 0.153, p = 0.005) and persisted for 6 months on average. The infants with and without LSV had similar perinatal characteristics, placental pathologies, cytomegalovirus infection rates, and clinical morbidities. The late-onset LSV group comprised 45 (88.2%) infants who had a significantly higher rate of being small for gestational age (SGA) and used oxygen for longer than the infants without LSV. After adjusting a multivariable regression model for GA and SGA, analysis showed that the duration of oxygen usage was an independent risk factor for late-onset LSV development in VLBW infants (odds ratio: 1.030, p = 0.032). Conclusion: LSV may be a nonspecific marker of perinatal insult to the developing brains of preterm infants. Prolonged postnatal oxygen usage may predispose VLBW preterm infants to late-onset LSV development. The long-term clinical impacts of LSV should be clarified.

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