Related Experiment Video
Updated: Jan 1, 2026
State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
Cranial Ultrasound and Minor Motor Abnormalities at 2 Years in Extremely Low Gestational Age Infants
Sara B DeMauro1,2, Carla Bann3, John Flibotte1,2
1Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Insights
Neonatal cranial ultrasounds (CUS) do not reliably predict minor motor abnormalities in preterm infants at 2 years corrected age. These common abnormalities are linked to increased functional impairment and resource needs.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Neuroimaging
Background:
- Extremely preterm infants (<27 weeks) are at high risk for neurodevelopmental deficits.
- Neonatal cranial ultrasound (CUS) is a common tool for assessing brain structure in preterm infants.
- The predictive value of early CUS findings for subtle motor deficits remains unclear.
Purpose of the Study:
- To determine if neonatal CUS abnormalities predict minor motor abnormalities at 2 years corrected age (CA) in extremely preterm infants.
- To assess functional outcomes and resource utilization in children with minor motor abnormalities.
Main Methods:
- Retrospective cohort study of infants born <27 weeks gestation (N=2306).
- Neonatal CUS performed <28 days and ≥28 days; neurodevelopmental assessment at 18-26 months CA.
- Motor function classified as none, minor, or major abnormality based on Bayley-3, neuromotor exam, and GMFCS level.
Main Results:
- Minor motor abnormalities were common (35%) and not strongly predicted by neonatal CUS findings.
- More severe CUS findings were associated with increased odds of minor axial/upper extremity abnormalities and GMFCS level 1.
- Children with minor motor abnormalities showed increased resource utilization and functional impairment.
Conclusions:
- Minor motor abnormalities in extremely preterm infants are frequent and not solely predictable by neonatal CUS.
- These subtle motor deficits are associated with significant functional impairments and increased healthcare resource needs.
- Findings emphasize the need for early counseling and tailored follow-up for extremely preterm infants.
Objectives:
The objectives of this study are to determine whether abnormalities on neonatal cranial ultrasound (CUS) are associated with minor motor abnormalities at 2 years' corrected age (CA) and to assess functional outcomes and resource utilization among children with minor motor abnormalities.
Methods:
Infants born at <27 weeks in the National Institute of Child Health and Human Development Neonatal Research Network between January 1, 2010, and December 31, 2014, who underwent neuroimaging with CUS at both <28 days and ≥28 days and were evaluated at 18 to 26 months' CA, were included. Follow-up included Bayley-3, neuromotor examination, Gross Motor Function Classification System (GMFCS) level, and parent questionnaires about special services and resource needs. Children were classified by the most severe motor abnormality at 18 to 26 months' CA as follows: none, minor, or major motor function abnormality. Minor motor abnormalities were defined as any of the following: (1) Bayley-3 motor composite, fine motor score, or gross motor score 1 to 2 SDs below the test normative means; (2) mild abnormalities of axial or extremity motor skills on standardized neuromotor examination; or (3) GMFCS level 1.
Results:
A total of 809 (35%) of 2306 children had minor motor function abnormalities alone. This did not increase substantially with CUS findings (no intraventricular hemorrhage [IVH]: 37%, grade I IVH: 32%, grade II IVH: 38%, grade III/IV IVH: 30%, isolated ventriculomegaly: 33%, and cystic periventricular leukomalacia: 24%). The adjusted odds of minor axial and upper extremity function abnormalities and GMFCS level 1 were significantly higher in children with more severe CUS findings. Children with minor motor abnormalities had increased resource utilization and evidence of functional impairment compared with those without motor function abnormalities.
Conclusion:
Minor motor abnormalities at 2 years' CA are common and cannot be predicted by neonatal CUS abnormalities alone. Minor motor abnormalities are associated with higher resource utilization and evidence of functional impairment. These findings have important implications for early counseling and follow-up planning for extremely preterm infants.
