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Updated: Aug 23, 2025
State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
Evaluation of a Cranial Ultrasound Screening Protocol for Very Preterm Infants
Glenda McLean1,2, Michael Ditchfield1,3,4, Eldho Paul5
1Diagnostic Imaging Department, Monash Health, Monash Medical Centre, Clayton, VIC, Australia.
Insights
A single cranial ultrasound (cUS) screening around day 8 is sufficient for low-risk preterm neonates (26-31 weeks GA). This approach avoids missing significant abnormalities in this group, optimizing screening protocols.
Area of Science:
- Neonatal Neurology
- Pediatric Radiology
- Perinatal Medicine
Background:
- Cranial ultrasound (cUS) screening is standard for preterm neonates (<32 weeks gestational age).
- Current protocols often involve multiple screening examinations.
- The necessity of both day 3 and day 8 cUS for all preterm infants requires evaluation.
Purpose of the Study:
- To determine if a day 3 and day 8 cUS screening is essential for all preterm neonates.
- To assess the necessity of early serial cranial ultrasounds in preterm infants.
- To optimize cUS screening protocols for preterm neonates.
Main Methods:
- Retrospective observational study at a tertiary Australian hospital.
- Comparison of cranial ultrasound abnormality (CUA) frequencies on days 3, 8, and 42.
- Logistic regression analysis of risk factors for intraventricular hemorrhage (IVH).
Main Results:
- 712 preterm neonates (<32 weeks GA) were analyzed, divided into early (23-25 weeks) and late (26-31 weeks) GA groups.
- CUAs were more frequent in the earlier GA group and in higher-risk infants in the later GA group.
- Low-risk infants (26-31 weeks GA) showed no significant difference in CUAs between day 3 and day 8 screenings; risk factors for IVH on day 8 were identified.
Conclusions:
- A single early cUS examination around day 8 is adequate for low-risk preterm neonates (26-31 weeks 6 days GA).
- This streamlined approach can identify substantial abnormalities without missing significant findings.
- Optimized screening may reduce unnecessary procedures for certain preterm infant populations.
Objectives:
Cranial ultrasound (cUS) screening is recommended for preterm neonates born before 32 weeks' gestational age (GA). The primary aim of this study was to determine if both a day 3 and day 8 cUS screening examination is necessary for all neonates.
Methods:
A retrospective observational study was performed at a tertiary-level Australian hospital. Frequencies of cranial ultrasound abnormality (CUA) were compared between routine screening performed at postnatal days 3, 8, and 42. Univariate and multivariate analyses of risk factors for intraventricular hemorrhage (IVH) was performed using logistic regression.
Results:
cUS examinations on 712 neonates born before 32 weeks' GA were included. Neonates were divided into 2 groups: 99 neonates in the 23-25 weeks 6 days GA (group A) and 613 neonates in the 26-31 weeks 6 days GA (group B). All CUA occurred more frequently in group A neonates and in the subset of group B neonates who had defined risk factors. Low-risk group B neonates had lower incidence of CUAs demonstrated on day 8 cUS than high-risk group B neonates, with no significant differences between day 3 and day 8. Logistic regression analysis identified a number of risk factors (vaginal delivery, small for GA, Apgar score <7 at 5 minutes, intubation, patent ductus arteriosus and infection) that were associated with increased frequency of IVH on day 8. In neonates born between 30 and 31 weeks 6 days GA, 35% had a CUA identified.
Conclusions:
Low-risk preterm neonates born between 26 and 31 weeks 6 days GA, without complications, could be screened with a single early cUS examination around day 8 without missing substantial abnormality.
