Intracranial hemorrhage in premature infants: accuracy in sonographic evaluation

The real-time high resolution mechanical sonographic sector scanner is a convenient and useful instrument for the detection of intracranial hemorrhage in premature infants. Experience with 27 infants with intracranial hemorrhage detected by sonography and confirmed by computed tomography (CT) or by autopsy is analyzed. The severity of the hemorrhage shown by those methods was graded by an accepted classification for standardized reporting. The extent of intraparenchymal and intraventricular hemorrhage was accurately assessed by sonography in all cases except for small amounts of blood in normal sized ventricles in five of 12 instances. Sonography also failed to detect subarachnoid hemorrhage in each of 13 cases. There were no known false-positive sonograms. From this experience the authors believe sonographic sector scanning should be the initial examination in all infants at high risk for intracranial hemorrhage. When the ventricles are of normal size, CT scanning is recommended to search for small intraventricular hemorrhage that may not be detected by sonography. For subarachnoid bleeding, CT is preferable to sonography.