Brain growth in sick newborn infants: a clinical and real-time ultrasound analysis

Abstract

This study concerns 152 neonates admitted between June 1981 and December 1983 in a neonatal intensive care unit. It aims to evaluate brain growth and to analyse the influence of intrauterine growth retardation (IUGR), intracranial haemorrhage (ICH) and ventricular dilatation (VD) in pre-term infants. The babies were first analysed at birth. The sample comprised 127 normal infants and 25 IUGR neonates. An ultrasonic index of cerebral growth was devised: the height of the frontal lobes (HFL), measured in a standardised coronal slice of the brain. According to gestational age (GA), HFL and head circumference (HC) gave a similar assessment of brain growth. A regression line of normal intrauterine values of HFL has been produced according to GA and might be added to the other ways of following the intrauterine growth of the brain after 26 weeks. Brain growth was slower in IUGR, when assessed both by HFL and HC. The infants were also assessed during the postnatal period for a mean period of 27.6 days (S.E.M.: 3.5). They were divided into 5 groups: 45 preterm infants without IUGR, ICH or VD; 45 preterm neonates with ICH alone; 12 preterm babies with ICH and VD alone, 10 preterm infants with isolated FGR, and 8 preterm neonates with IUGR and ICH. A calculation of the global anthropometric (body weight, body length, HC and HFL) weekly increment was made for all infants according to their respective group. No statistical difference in any of these parameters between these 5 groups emerged. This study showed that, at an anatomical level, and provided that nutrition is normal, HC is as sensitive as HFL to assess brain growth; when the whole body is growing normally, cerebral growth in preterm infants who experienced IUGR, ICH, VD, is comparable to that observed in preterm babies who did not.