早産児における連続頭蓋超音波検査の有用性

To describe and evaluate our single-center practice of serial cranial ultrasound (CUS) in preterm infants following the 2020 American Academy of Pediatrics (AAP) clinical report. To evaluate the rate of cranial abnormalities following the first normal scan and identify risk factors for severe intraventricular hemorrhage (IVH) in the first week of life.

A single-center retrospective study over an eight-year study period, from 2016-2023. Rates and types of CUS are described and compared over pre- and post-AAP clinical report time epochs. Risk factors associated with severe IVH were analyzed with logistic regression.

A total of 727 infants were included. Median number of CUS was 3 (2, 4, IQR) in both pre- and post-AAP cohort periods. CUS were performed in 289 (39.8%) infants before 7 days of life (DOL), 595 (81.8%) at 7-10 DOL, 623 (85.7%) at 4-6 weeks, and 361 (49.7%) at term equivalent age (TEA). The rates of abnormal CUS were 139 (48.1%), 364 (61.2%), 401 (64.4%), and 227 (62.9%) of the infants who had CUS at less than 7 days, 7-10 days, 4-6 weeks, and TEA, respectively. New abnormalities were detected in 13% (48/364) infants following a normal 7-10 DOL scan and 3% (9/290) following a normal 7-10 days and 4-6 weeks scan. Decreased birth gestational age (Odds Ratio, OR = 0.7) advanced resuscitation (OR = 3.4) and birth at outside hospital (OSH) (OR = 2.6) were associated with severe IVH before 7 DOL.

Our single-center practice of serial CUS was largely consistent with the AAP clinical report. We report that new findings of abnormality following a normal 7-10 DOL scan are infrequent and limited to grade 1 IVH and benign cysts. We identified birth gestation below 25 weeks, birth at an OSH, and advanced resuscitation as risk factors for severe IVH.