Consensus Approach for Standardizing the Screening and Classification of Preterm Brain Injury Diagnosed With Cranial Ultrasound: A Canadian Perspective.

Khorshid Mohammad,Bruno Piedboeuf,Linda S De Vries,Lara M Leijser,Gerda Van Wezel-Meijler,Hussein Zein,Shoo K Lee,Prakesh S Shah,James N Scott,Jehier Afifi

doi:10.3389/fped.2021.618236

Abstract

Acquired brain injury remains common in very preterm infants and is associated with significant risks for short- and long-term morbidities. Cranial ultrasound has been widely adopted as the first-line neuroimaging modality to study the neonatal brain. It can reliably detect clinically significant abnormalities that include germinal matrix and intraventricular hemorrhage, periventricular hemorrhagic infarction, post-hemorrhagic ventricular dilatation, cerebellar hemorrhage, and white matter injury. The purpose of this article is to provide a consensus approach for detecting and classifying preterm brain injury to reduce variability in diagnosis and classification between neonatologists and radiologists. Our overarching goal with this work was to achieve homogeneity between different neonatal intensive care units across a large country (Canada) with regards to classification, timing of brain injury screening and frequency of follow up imaging. We propose an algorithmic approach that can help stratify different grades of germinal matrix-intraventricular hemorrhage, white matter injury, and ventricular dilatation in very preterm infants.

Highlights

Brain injury remains a frequent and clinically significant problem in very preterm infants born at or before 32 weeks’ gestation [1]
Hemorrhage Germinal matrix hemorrhage – Intraventricular hemorrhage (GMH-intraventricular hemorrhage (IVH)) in preterm infants originates from the germinal matrix and can either be restricted to the germinal matrix or extend into the lateral ventricles
The classification is based on the amount and extension of hemorrhage into the lateral ventricles and the presence of acute ventricular dilatation, and is a strong predictor of neurodevelopmental outcomes [8]

Summary

Introduction

Brain injury remains a frequent and clinically significant problem in very preterm infants born at or before 32 weeks’ gestation [1]. Different types of lesions can affect the preterm infant’s brain including hemorrhagic lesions, ischemic lesions or maturation arrest [4]. Preterm Brain Injury Diagnosis Standarization small intraparenchymal hemorrhages and small ischemic lesions can sometimes be difficult to detect or differentiate using cUS. Some forms of brain injury including mild ischemic changes, can be difficult to distinguish from changes caused by normal maturational phenomena. At present MRI remains impractical as a routine screening tool, and at times this technique identifies subtle lesions with unproven significance. CUS remains the universal screening tool to identify and monitor brain injury in preterm neonates

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