Neonatal intracranial pathologies on ultrasound imaging in sub-Saharan Africa: a systematic review and meta-analysis

Annually, 30 million children are affected by newborn conditions, most in low-income countries, with long-term implications for survivors. We aimed to evaluate neonatal intracranial pathologies identifiable on cranial ultrasound (CUS) in sub-Saharan Africa (SSA). This systematic review and meta-analysis explored the spectrum of neonatal intracranial pathology, in nine databases, using the Joanna Briggs Institute Systematic Review Tools. The review was registered with PROSPERO (CRD42022309249). In total, 92 studies from 14 countries were identified, with South Africa (34%) and Nigeria (28%) most represented. Of these, 38 (42%) focused on intraventricular haemorrhage (IVH), 13 (14%) on congenital brain anomalies, 11 (12%) on intracranial infection, 9 (10%) on ventriculomegaly/hydrocephalus, and 7 (8%) on neonatal encephalopathy. IVH pooled prevalence was 29% (CI 23-35%), with a quarter high-grade (24%, CI 20-29%). Higher prevalence was seen at lower gestation (<32 weeks, 38% (CI 26-50%)) and birthweight (<1500 g, 32% (CI 24-40%)). Periventricular leukomalacia was less common than IVH (9% (CI 6-13%)). A spectrum of intracranial pathology has been reported on neonatal CUS from SSA. IVH affected close to one third of at-risk neonates, and PVL one in eleven, with potentially important implications for longer term outcomes for affected children. IMPACT: Newborn conditions, like prematurity and neonatal encephalopathy, are leading causes of under-5 child mortality, with the greatest burden in sub-Saharan Africa. Intracranial pathologies relating to newborn conditions, may have important long-term consequences, yet frequently go undetected in settings with limited access to imaging. We examined the spectrum and prevalence of different neonatal intracranial pathologies detectable on cranial ultrasound imaging from the sub-Saharan Africa region. A wide spectrum of intracranial pathology was reported, including a high prevalence of intraventricular haemorrhage and periventricular leukomalacia among small and preterm neonates, with potential important implications for childhood outcomes.