Utility of Serial Cranial Ultrasound in Preterm Infants.

Area of Science:

• Neonatal Neurology
• Pediatric Radiology
• Clinical Practice Guidelines

Background:

• The 2020 American Academy of Pediatrics (AAP) clinical report provides updated recommendations for serial cranial ultrasound (CUS) in preterm infants.
• Evaluating adherence to and outcomes following these guidelines is crucial for optimizing neonatal neuroprotection.

Purpose of the Study:

• To assess a single-center's adherence to the 2020 AAP CUS guidelines.
• To determine the incidence of new cranial abnormalities after a normal initial scan.
• To identify risk factors for severe intraventricular hemorrhage (IVH) within the first week of life.

Main Methods:

• A retrospective eight-year study (2016-2023) of preterm infants undergoing serial CUS.
• Comparison of CUS practices and outcomes pre- and post-AAP guideline implementation.
• Logistic regression analysis to identify risk factors for early severe IVH.

Main Results:

• Serial CUS frequency remained consistent (median 3 scans) across pre- and post-AAP periods.
• New abnormalities were infrequent after a normal 7-10 day of life (DOL) scan (13%) and even rarer after normal scans at 7-10 DOL and 4-6 weeks (3%).
• Decreased gestational age (<25 weeks), advanced resuscitation, and birth at an outside hospital were significant risk factors for severe IVH before 7 DOL.

Conclusions:

• The center's serial CUS practice generally aligns with the 2020 AAP report.
• New cranial abnormalities detected after a normal early CUS are uncommon and typically mild (Grade 1 IVH, benign cysts).
• Gestational age, mode of resuscitation, and place of birth are critical factors influencing the risk of severe early IVH.