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Screening head ultrasound to detect intraventricular hemorrhage in premature infants
P R Chess1, M A Chess, M A Manuli
1Department of Pediatrics, University of Rochester, Strong Memorial Hospital, Rochester, NY 14642, USA.
Insights
This study developed a refined head ultrasound (HUS) screening protocol for very-low-birthweight infants to accurately detect high-grade intraventricular hemorrhage (IVH). The new criteria improve specificity, reducing unnecessary scans while maintaining high sensitivity for detecting IVH.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Medical Imaging
Background:
- Intraventricular hemorrhage (IVH) is a significant concern in very-low-birthweight infants.
- Current screening methods for high-grade IVH may lack optimal specificity.
- Developing a more precise screening protocol is crucial for timely intervention.
Purpose of the Study:
- To create a head ultrasound (HUS) screening protocol for detecting high-grade intraventricular hemorrhage (IVH) in very-low-birthweight infants.
- To enhance the specificity of IVH screening compared to current practices.
- To maintain a high sensitivity in identifying infants with high-grade IVH.
Main Methods:
- A case-control study analyzed infants born at or before 32 weeks gestation or weighing at or below 1500 g.
- The 1991 cohort data were used to identify factors predicting high-grade (III or IV) IVH.
- Refined screening criteria were developed based on sensitive and specific predictive factors.
Main Results:
- Eighty-five percent of infants born at 28-32 weeks gestation screened by 2 weeks had normal HUS scans.
- Key predictors for high-grade IVH included gestational age < 28 weeks, forceps delivery, seizures, rapid head circumference increase, base deficit ≥10, or cardiopulmonary resuscitation.
- These factors allowed for more targeted screening.
Conclusions:
- A refined HUS screening protocol can identify very-low-birthweight infants with high-grade IVH with high sensitivity.
- The developed criteria can potentially eliminate 50% of currently performed HUS scans for IVH screening.
- This approach optimizes resource utilization while ensuring detection of critical IVH cases.
Objective:
The objective of this case-control study was to develop a screening protocol using head ultrasound (HUS) to detect high-grade intraventricular hemorrhage (IVH) in very-low-birthweight infants with greater specificity than current practice, while maintaining a high degree of sensitivity.
Materials And Methods:
All infants
Results:
Eighty-five percent of infants born at 28-32 weeks gestation screened by 2 weeks of age for IVH had normal HUS scans. The factors most predictive of a high-grade IVH were gestational age < 28 weeks, forceps delivery, or any of the following in the first 2 weeks of life: seizures, head circumference increasing by more than 1 cm per week, base deficit >/= 10, or cardiopulmonary resuscitation in the neonatal intensive care unit.
Conclusion:
Infants born at 28-32 weeks with a high-grade IVH can be identified with a high degree of sensitivity using refined screening criteria, eliminating 50 % of the HUS scans currently obtained for IVH screening.