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Ultrasonography of the brain in preterm infants and its correlation with neurodevelopmental outcome
S Chaudhari1, A S Kinare, R Kumar
1Department of Pediatrics, K.E.M. Hospital, Pune.
Insights
Ultrasonography (USG) brain scans on the third day of life effectively detect intraventricular/periventricular hemorrhage in preterm neonates. A normal USG at term accurately predicts good neurodevelopmental outcomes.
Area of Science:
- Neonatal Neurology
- Pediatric Radiology
- Neurodevelopmental Pediatrics
Background:
- Preterm neonates are at high risk for brain injury, particularly intraventricular/periventricular hemorrhage (IVH/PVH).
- Early detection and monitoring of brain abnormalities are crucial for predicting neurodevelopmental outcomes in this vulnerable population.
Purpose of the Study:
- To evaluate the efficacy of serial brain ultrasonography (USG) in detecting IVH/PVH in preterm neonates.
- To assess the predictive value of USG at term-equivalent age for neurodevelopmental outcomes using the Bayley Scales of Infant Development.
Main Methods:
- Two hundred and eighteen preterm neonates underwent brain USG on the third, seventh, and/or fourteenth day of life.
- Serial USGs were performed on 63 neonates on the third and seventh days.
- USG at term-equivalent age (40 weeks postconceptual age) was conducted in 99 infants, with 72 undergoing developmental assessment at one year.
Main Results:
- Intraventricular/periventricular hemorrhage occurred in 26.3% of neonates; parenchymal lesions were seen in 3.
- Hemorrhage grades varied, with higher grades associated with lower gestational age (p = 0.0001).
- Ninety-four percent of bleeds were detected by the third day of life. USG at term showed 89.2% specificity and 90% negative predictive value for predicting neurodevelopmental outcomes.
Conclusions:
- Early USG on the third day of life is opportune for detecting brain hemorrhages in preterm infants.
- A normal USG at term-equivalent age is a reliable predictor of good neurodevelopmental outcomes, including normal development at one year.
Abstract:
Two hundred and eighteen preterm neonates had ultrasonography (USG) brain done on third, and/or seventh and fourteenth day of life. Fifty eight (26.3%) had intraventricular/ periventricular hemorrhage, 3 had parenchymal lesions. 46 had Grade I hemorrhage, 9 had Grade II, 2 had Grade III and 1 had Grade IV hemorrhage. Grade III and IV hemorrhages occurred in neonates below 34 weeks gestation. There was an inverse relationship between gestation age and hemorrhage (p = 0.0001). A comparison of incidence of hemorrhage between preterms who were appropriate for gestational age was not significant. Out of the 63 neonates who had serial USGs on the third and seventh day of life, 15 of the 16 bleeds (94%) were detected on the third day itself, indicating it to be a opportune time for doing an USG. USG at term (40 weeks postconceptual age) was done in 99 infants to see if it could correctly predict the neurodevelopmental outcome using the Bayley Scales of Infant Development. Out of these 99 infants, 72 came for the developmental assessment at one year. One neonate who had periventricular leucomalacia with cystic changes on USG at term, was grossly abnormal with cerebral palsy and mental retardation. Six infants showed delayed development with a mean mental development quotient of 79.1 +/- 1.72 at 2 years. The specificity of USG at term for predicting outcome was 89.2% and negative predictive outcome was 90%, indicating that a normal USG at term predicted a good neurodevelopmental outcome.