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Neonatal cranial ultrasound screening for intraventricular haemorrhage
1Division of Neonatology, Mater Mothers' Hospital, South Brisbane, Queensland, Australia.
Insights
Routine cranial ultrasounds for high-risk infants to detect intraventricular haemorrhage (IVH) may not be cost-effective. Current practices scan infants multiple times, raising questions about diagnostic value and resource allocation.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Medical Imaging
Background:
- Neonatal cranial ultrasound screening for intraventricular haemorrhage (IVH) became prevalent in the 1980s.
- Current protocols involve multiple scans for high-risk and extremely low birthweight (ELBW) infants.
- Ultrasound findings are often used to predict neurodevelopmental outcomes.
Purpose of the Study:
- To evaluate the cost-effectiveness of routine neonatal cranial ultrasound scans for diagnosing IVH in high-risk infants.
- To critically assess the current screening practices and their diagnostic yield.
- To inform clinical guidelines regarding IVH detection and resource utilization.
Main Methods:
- Review of existing literature and meta-analyses on neonatal cranial ultrasound for IVH.
- Analysis of current screening protocols in neonatal units.
- Cost-effectiveness analysis of routine versus selective screening approaches.
Main Results:
- The cost-effectiveness of current routine screening protocols is questionable.
- The diagnostic utility of multiple scans for IVH detection needs re-evaluation.
- The use of ultrasound as a sole surrogate for neurodevelopmental outcome assessment is debated.
Conclusions:
- Re-evaluation of routine neonatal cranial ultrasound protocols for IVH is warranted.
- Optimizing screening strategies may improve cost-effectiveness and resource allocation.
- Further research is needed to refine the prediction of neurodevelopmental outcomes in preterm infants.
Abstract:
The cost effectiveness of performing routine neonatal cranial ultrasound scans to diagnose intraventricular haemorrhage (IVH) on cohorts of high risk infants is in question. In the early 1980s cranial ultrasound scans were performed on preterm infants to expand knowledge of the incidence, aetiology, pathogenesis and evolution of IVH. In many neonatal units high risk infants are scanned on days 5-7 and 10-14 and prior to discharge for extremely low birthweight (ELBW) infants. Cranial ultrasound scanning is often used as a surrogate for assessment of neurodevelopmental outcome with information from meta analyses used to counsel parents about the likelihood of subsequent neurosensory disability.