Indications for routine cranial ultrasound scanning in the nursery

Cranial ultrasonography provides important diagnostic information in neonates. The clinical indications for routine scanning in newborn infants, however, are not established. The purpose of this study is to determine the incidence of cranial pathology detectable by ultrasound in certain clinical states in the neonate. We reviewed the scans and clinical states of 1,031 neonates born between April 1981 and February 1985. We found term infants with dysmorphic features to have the highest incidence of neuropathology (46%), followed by term infants born with macrocephaly (33%), preterm infants (26%), term infants with seizures (26%), and term infants with 1- and 5-min Apgar scores less than 7 (13%). We found a lower incidence (less than 5%) of abnormal CNS findings in the nonasphyxiated term infants with split sutures, cephalohematoma, abnormal neurologic examination, and idiopathic jitteriness. Based on our findings we have concluded that it is important to scan routinely all premature infants, term infants with dysmorphic features, macrocephaly, or seizure disorder, and infants with 1- and 5-min Apgar scores less than 7; routine scanning of term infants with split sutures, cephalohematoma, abnormal neurological examination, or idiopathic jitteriness is not indicated.