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Updated: Oct 10, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Relationships between early postnatal cranial ultrasonography linear measures and neurobehaviour at term-equivalent
Rocco Cuzzilla1, Joy E Olsen2, Abbey L Eeles3
1Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.
Insights
Early brain size and growth in preterm infants predict later neurobehavior. Cranial ultrasonography measures show potential for early neurodevelopmental assessments in high-risk newborns.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Medical imaging
Background:
- The link between early brain development and neurobehavior at term-equivalent age (TEA) in preterm infants is not fully understood.
- Understanding this relationship is crucial for identifying infants at risk for neurodevelopmental impairments.
Purpose of the Study:
- To investigate the association between early postnatal brain size and growth, measured by cranial ultrasonography (cUS), and neurobehavior at TEA.
- To explore the prognostic utility of cUS linear measures in preterm infants.
Main Methods:
- A prospective observational cohort study was conducted.
- 137 infants born before 30 weeks' gestational age without major brain injury were included.
- Neurobehavior was assessed using the General Movements Assessment (GMA) and Hammersmith Neonatal Neurological Examination (HNNE).
Main Results:
- Larger corpus callosum length and anterior horn width at 1 month correlated with a lower risk of abnormal general movements.
- Larger biparietal diameter at 1 week and 2 months was associated with a lower risk of suboptimal Hammersmith Neonatal Neurological Examination scores.
- Increased brain growth metrics between birth and 2 months were linked to better neurobehavioral outcomes.
Conclusions:
- Early postnatal brain size and growth, as assessed by cUS, are related to neurobehavior at TEA in very preterm infants.
- These findings suggest that early cUS linear measures may serve as potential markers for predicting neurodevelopmental outcomes in later childhood.
Background:
The relationship between early postnatal brain development and neurobehaviour at term-equivalent age (TEA) remains uncertain.
Aim:
We aimed to explore relationships between early postnatal cranial ultrasonography (cUS) linear measures of brain size and brain growth with neurobehaviour at TEA in infants born <30 weeks' gestational age (GA).
Study Design:
Prospective observational cohort study.
Subjects:
137 infants born <30 weeks' GA without major brain injury on neonatal cUS.
Outcome Measures:
Neurobehaviour at TEA assessed using the General Movements Assessment (GMA) and Hammersmith Neonatal Neurological Examination (HNNE).
Results:
The GMA was administered in 115/137 (84%) infants; 80 (70%) presented with abnormal general movements (GMs) (79 poor repertoire, 1 cramped synchronised). The HNNE was assessed in 106/137 (77%) infants; 52 (49%) had a suboptimal total score. With respect to brain size, larger measures of the corpus callosum length (CCL) and right anterior horn width (AHW) at 1-month were related to lower risk of abnormal GMs, and larger measures of the biparietal diameter at 1-week and 2-months were related to lower risk of a suboptimal HNNE. As for brain growth, increases of the CCL and transcerebellar diameter between birth and 1-month, and left and right AHWs between 1- and 2-months, were related to lower risk of abnormal GMs.
Conclusion:
Early postnatal brain size and brain growth were related to neurobehaviour at TEA in infants born <30 weeks' GA. This study provides preliminary evidence for the prognostic utility of early postnatal cUS linear measures as potential markers of neurodevelopment in later childhood.
