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Serial head ultrasound studies in preterm infants: how many normal studies does one infant need to exclude
Victoria N Nwafor-Anene1, Joseph D DeCristofaro, Stephen Baumgart
1Division of Neonatology, Department of Pediatrics, University Hospital and Medical Center, State University of New York at Stony Brook, Stony, New York 11794-8111, USA.
Insights
Two normal head ultrasounds (HUS) in preterm infants > 25 weeks gestation predict subsequent normal scans. Extremely premature infants (<25 weeks) require repeat HUS due to risks of severe brain abnormalities.
Area of Science:
- Neonatal neurology
- Pediatric neuroimaging
- Perinatal medicine
Background:
- Head ultrasounds (HUS) are crucial for monitoring brain development in preterm infants.
- Identifying reliable indicators for discontinuing routine HUS screening is essential for resource optimization and reducing infant stress.
Purpose of the Study:
- To evaluate the predictive value of two normal head ultrasound (HUS) screening studies, separated by at least 7 days, for subsequent normal follow-up studies in preterm infants.
Main Methods:
- Retrospective review of HUS reports for preterm infants (≤32 weeks gestation) admitted between January 1998 and July 2000.
- Defined normal and abnormal HUS findings, including various grades of intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), ventriculomegaly (VM), and periventricular echogenicity (PVE).
Main Results:
- Of 98 infants, 94% with two normal HUS studies ≥7 days apart had normal subsequent scans.
- The positive predictive value for normal follow-up after two normal screens was 94%, with 86% specificity.
- Abnormal outcomes were more frequent in infants <25 weeks gestation or those with significant clinical deterioration.
Conclusions:
- Stable preterm infants ≥25 weeks gestation with two normal HUS studies ≥7 days apart may not require further routine screening.
- Extremely premature infants (<25 weeks gestation) remain at risk for late-onset severe brain abnormalities and necessitate repeat HUS before discharge.
Objective:
We hypothesized that preterm infants with two normal head ultrasound (HUS) screening studies > or = 7 days apart would have subsequently normal follow-up studies.
Population:
We reviewed reports of all HUS studies performed in preterm infants < or = 32 weeks gestation admitted to our nursery between January 1998 and July 2000.
Setting:
Regional perinatal referral center.
Design:
A normal HUS screening study was defined as either no findings; or grade I intraventricular hemorrhage (IVH) (Papile classification), germinal matrix irregularity or cyst, or normal but unequal ventricular size. An abnormal study was defined as any with IVH > or = grade II, periventricular leukomalacia (PVL), ventriculomegaly (VM), or periventricular echogenicity (PVE).
Results:
Of 98 infants, 92 infants (94%) who had two normal HUS studies > or = 7 days apart had normal repeat studies subsequently, and six (6%) were abnormal. Four of the six abnormal infants were <25 weeks gestation at birth. One infant (27 weeks) became abnormal after culture-positive bacterial sepsis and necrotizing enterocolitis with bowel perforation requiring surgery. The remaining infant (29 weeks) had a question of PVE, and a normal repeat study. The positive predictive value for having a normal HUS after two previously normal studies > or = 7 days apart was 94% with a specificity of 86%.
Conclusion:
Stable premature infants > or = 25 weeks gestation without intervening deterioration may not need repeat screening HUSs after having had two normal studies > or = 7 days apart. Unstable or extremely premature infants <25 weeks gestation may be subject to late severe IVH, VM, and PVL, and therefore need a repeat study before hospital discharge, even if two initial studies > or = 7 days apart were normal.