Cranial Ultrasound Morphometry and Head Circumference at Term-Equivalent Age Are Associated with Early...

Background and Objectives: Advances in perinatal and neonatal care have improved survival in preterm infants, yet neurodevelopmental impairment remains a major concern. A considerable proportion of preterm infants with normal or only mildly abnormal neuroimaging findings still develop neurodevelopmental difficulties, highlighting the need for more sensitive imaging markers beyond the detection of major brain lesions. Cranial ultrasound is a widely used bedside imaging tool that enables both detection of brain injury and quantitative assessment of brain growth. This study aimed to evaluate the association between early and term-equivalent cranial ultrasound morphometric parameters, head circumference, and neurodevelopmental outcomes assessed by the Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-4). Materials and Methods: This exploratory observational study included 22 preterm infants admitted to a neonatal intensive care unit. Cranial ultrasound examinations were performed within the first 72 h of life and at term-equivalent age (37-40 weeks postmenstrual age). Measured parameters included the Levene index, lateral ventricular width, third ventricle width, subarachnoid space, and interhemispheric fissure. Head circumference was analyzed as an additional marker of postnatal brain growth. Neurodevelopment was assessed at 12-14 months corrected age using Bayley-4. Associations were analyzed using Spearman's rank correlation. Results: Significant correlations were more frequent at term-equivalent age than in the early neonatal period. Early measurements showed positive associations between ventricular parameters and motor outcomes, as well as between head circumference and receptive communication (p < 0.01). Third ventricle width was also associated with receptive communication. At term-equivalent age, lateral ventricular width demonstrated consistent negative correlations with motor and language outcomes, with strong associations in motor domains (p < 0.01). Head circumference showed limited positive associations, reaching significance only for personal-social skills, while third ventricle width was associated with play and leisure activities. Conclusions: Morphometric cranial ultrasound measurements, particularly those obtained at term-equivalent age, may provide valuable additional information about early neurodevelopment in preterm infants. Head circumference reflected postnatal brain growth but showed less consistent associations with neurodevelopmental outcomes than ventricular morphometric parameters. Larger prospective studies with longer follow-up are needed to confirm these findings and define the prognostic value of individual cranial ultrasound morphometric parameters and head circumference for predicting neurodevelopmental outcomes in preterm infants.