Analyses of pathological cranial ultrasound findings in neonates that fall outside recent indication guidelines: results of a population-based birth cohort: survey of neonates in Pommerania (SNiP-study)

Judith Weise,Heike Allenberg,Hagen Bahlmann,Grzegorz Domanski,Matthias Heckmann,Till Ittermann,Anja Erika Lange

doi:10.1186/s12887-019-1843-6

Judith Weise, Heike Allenberg + Show 5 more

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https://doi.org/10.1186/s12887-019-1843-6

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Journal: BMC Pediatrics	Publication Date: Dec 1, 2019
Citations: 4	License type: open-access

Affiliation: Greifswald University Hospital

Abstract

BackgroundRecent guidelines recommend a cranial ultrasound (CU) in neonates born at < 30 weeks gestation, admitted to the neonatal intensive care unit (NICU), or with a CU indication. Here, we addressed the need to extend these recommendations.MethodsWe retrospectively reviewed 5107 CUs acquired in the population-based Survey of Neonates in Pomerania, conducted in 2002 to 2008. Neonates with conspicuous CUs that were ≥ 30 weeks gestation without recent indications for CU were identified and assigned to the following groups: with (I) or without (II) admission to neonatal care. We designated CU conspicuities as mild (MC) or significant (SC), and we investigated related neurodevelopment during follow-up.ResultsOf 5107 neonates, 5064 were born at ≥30 weeks gestation and of those, 4306 received CUs without any indication for this examination. We found conspicuities in 7.7% (n = 47/610) of group I (n = 30 MC, n = 17 SC), and 3.2% (n = 117/3696) of group II (n = 100 MC, n = 17 SC). In group II, SC comprised, e.g., bilateral cysts, partial agenesis of the corpus callosum, and periventricular leukomalacia. Follow-up was available in 75% of infants in group II with MCs and SCs; of these, 12.8% had an abnormal neurological follow-up.ConclusionsWe detected a high number of conspicuities in neonates without a CU indication. However, we could not demonstrate that ultrasound findings were associated with the neurological follow-up or any advantage to an earlier diagnosis. Our data did not support extending current guidelines or a general CU screening policy for all neonates.

Highlights

Recent guidelines recommend a cranial ultrasound (CU) in neonates born at < 30 weeks gestation, admitted to the neonatal intensive care unit (NICU), or with a CU indication
To evaluate the prevalence and severity of diagnoses in infants that fell outside the recent recommendations for CU, we identified all neonates with CU conspicuities that were born ≥30 weeks Weeks of gestational age (GA) without indication, and grouped them as follows: neonates with admission and without admission to neonatal care unit (NCU) after birth [5]
Significant anomalies, like corpus callosum hypoplasia, periventricular leukomalacia (PVL), and Intraventricular hemorrhage (IVH) indication for CU (II)°, were not associated with a conspicuous neurological follow-up; we lacked a correlation between conspicuous CU findings and neurological impairments [8, 9]

Summary

Introduction

Recent guidelines recommend a cranial ultrasound (CU) in neonates born at < 30 weeks gestation, admitted to the neonatal intensive care unit (NICU), or with a CU indication. The cranial ultrasound (CU) is a cost-effective, portable, non-invasive examination that does not require radiation. The Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Science recommend routine CU screening for all neonates < 30 weeks of gestational age (weeks GA) [3]. Beyond those recommendations, Leijser et al claimed to include neonates that were admitted to the neonatal care unit (NCU) after birth [4].

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