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State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
Day 1 Cranial Ultrasonography Detects Prenatal Brain Abnormalities in Preterm Infants: A Retrospective Cohort Study
Rim Kasem Ali Sliman1,2, Michal Molad2,3, Dan Waisman2,3
1Pediatrics, Carmel Medical Center, Haifa, Israel.
Insights
Day 1 cranial ultrasonography (CUS) in preterm infants reveals prenatal brain abnormalities across all gestational ages. Early intraventricular hemorrhage (IVH) may resolve before standard screening, suggesting a need for earlier CUS evaluation.
Area of Science:
- Neonatal Neurology
- Pediatric Radiology
- Neurodevelopmental Pediatrics
Background:
- Current guidelines recommend cranial ultrasonography (CUS) screening for preterm infants at 7-14 days of life.
- Delayed screening may miss significant prenatal brain injuries in neonates.
- Evidence suggests earlier CUS could improve detection of early brain abnormalities.
Purpose of the Study:
- To assess the diagnostic utility of day 1 CUS for identifying prenatal brain abnormalities in preterm infants.
- To evaluate the prevalence of brain pathology by gestational age groups on day 1 CUS.
- To determine the occurrence and resolution patterns of intraventricular hemorrhage (IVH) and white matter lesions.
Main Methods:
- Retrospective cohort study of 365 preterm infants (24.0-36.6 weeks gestation) undergoing CUS within 24 hours of birth.
- Analysis of CUS findings, focusing on prenatal hemorrhage and white matter abnormalities, stratified by gestational age.
- Independent review by two neonatologists with consensus for discordant findings.
Main Results:
- Day 1 CUS identified abnormalities in 38.6% of infants, with higher rates in extremely preterm infants (63.8%).
- Intraventricular hemorrhage (IVH) was present in 15.9% of infants, with 53.4% showing signs of prenatal onset; 24.1% of these resolved by follow-up.
- White matter lesions were found in 13.4% of infants, predominantly in extremely preterm neonates (36.2%).
Conclusions:
- Day 1 CUS detects findings suggestive of prenatal brain pathology in preterm infants across all gestational ages.
- A significant proportion of early IVH cases resolve before conventional screening, highlighting potential missed diagnoses.
- Earlier CUS warrants consideration as an adjunct to current protocols, pending prospective studies with neurodevelopmental outcomes.
Abstract:
BackgroundCurrent guidelines recommend cranial ultrasonography (CUS) screening at 7-14 days for infants <30 weeks of gestation. However, emerging evidence suggests that significant prenatal brain injuries may be missed by delayed screening protocols.ObjectiveTo evaluate the diagnostic yield of day 1 CUS in identifying prenatal brain abnormalities across all preterm gestational ages.MethodsRetrospective cohort study of 365 preterm infants (24.0-36.6 weeks of gestation) who underwent CUS within 24 hours of birth at a tertiary neonatal intensive care unit (June 2014-July 2020). CUS findings were analyzed by gestational age groups, with particular attention to signs of prenatal hemorrhage and white matter abnormalities. Images were independently reviewed by 2 board-certified neonatologists with consensus review for discordant cases.ResultsDay 1 CUS revealed pathologic findings in 141 of 365 infants (38.6%), with gestational age-dependent prevalence: 44 of 69 (63.8%) extremely preterm (24-30 weeks), 53 of 129 (41.1%) very preterm (30.1-33.6 weeks), and 44 of 167 (26.3%) moderate to late preterm (34-36.6 weeks). Intraventricular hemorrhage (IVH) occurred in 58 of 365 infants (15.9%), with 31 of 58 cases (53.4%) showing clot liquefaction suggestive of prenatal onset. Critically, 14 of 58 IVH cases (24.1%) completely resolved on follow-up imaging. White matter lesions were identified in 49 of 365 infants (13.4%), demonstrating marked gestational age dependence: 25 of 69 (36.2%) extremely preterm, 23 of 129 (17.8%) very preterm, and 1 of 167 (0.6%) moderate-late preterm infants.ConclusionsDay 1 CUS identifies findings suggestive of prenatal brain pathology across all preterm gestational ages. Nearly one-quarter of early IVH cases resolve before conventional screening times. These findings suggest that earlier CUS may warrant further evaluation as a potential adjunct to current protocols; however, prospective studies with neurodevelopmental follow-up are needed before any change to screening practice can be recommended.
