Abstract
BackgroundPremature infants are at risk for multiple types of intracranial injury with potentially significant long-term neurological impact. The number of screening head ultrasounds needed to detect such injuries remains controversial.ObjectiveTo determine the rate of abnormal findings on routine follow-up head ultrasound (US) performed in infants born at ≤ 32 weeks’ gestational age (GA) after initial normal screening US.Materials and methodsA retrospective study was performed on infants born at ≤ 32 weeks’ GA with a head US at 3–5 weeks following a normal US at 3–10 days at a tertiary care pediatric hospital from 2014 to 2020. Exclusion criteria included significant congenital anomalies, such as congenital cardiac defects necessitating surgery, congenital diaphragmatic hernia or spinal dysraphism, and clinical indications for US other than routine screening, such as sepsis, other risk factors for intracranial injury besides prematurity, or clinical neurological abnormalities. Ultrasounds were classified as normal or abnormal based on original radiology reports. Images from initial examinations with abnormal follow-up were reviewed.ResultsThirty-three (14.2%) of 233 infants had 34 total abnormal findings on follow-up head US after normal initial US. Twenty-seven infants had grade 1 germinal matrix hemorrhage, and four had grade 2 intraventricular hemorrhage. Two had periventricular echogenicity and one had a focus of cerebellar echogenicity that resolved and was determined to be artifactual.ConclusionWhen initial screening head ultrasounds in premature infants are normal, follow-up screening ultrasounds are typically also normal. Abnormal findings are usually limited to grade 1 germinal matrix hemorrhage.
Highlights
The developing brain of premature infants is at risk for several major types of pathology: germinal matrix hemorrhage with or without intraventricular hemorrhage (IVH), cerebellar hemorrhage, ventriculomegaly and white matter injury
Germinal matrix hemorrhage with or without IVH is the most common abnormality found on head ultrasound (US), reported in more than 30% of infants born at ≤ 28 weeks’
Nwafor-Anene et al [31] found that of 98 premature infants with 2 initial normal or “slightly abnormal” head ultrasounds at least a week apart, 94% continued to have normal ultrasounds at 1 month and beyond; the 6 infants who had abnormal follow-up ultrasounds were clinically unstable with significant comorbidities such as necrotizing enterocolitis or sepsis
Summary
The developing brain of premature infants is at risk for several major types of pathology: germinal matrix hemorrhage with or without intraventricular hemorrhage (IVH), cerebellar hemorrhage, ventriculomegaly and white matter injury. Germinal matrix hemorrhage with or without IVH is the most common abnormality found on head ultrasound (US), reported in more than 30% of infants born at ≤ 28 weeks’. Cerebellar hemorrhage has been detected on head US in up to 9% of infants born at < 32 weeks’ GA when views are performed through the mastoid fontanelle in addition to the anterior fontanelle [2] All of these brain injuries can initially be clinically silent but are often associated with long-term motor, cognitive and sensory impairment [3,4,5,6,7,8,9,10]. Objective To determine the rate of abnormal findings on routine follow-up head ultrasound (US) performed in infants born at ≤ 32 weeks’ gestational age (GA) after initial normal screening US. Abnormal findings are usually limited to grade 1 germinal matrix hemorrhage
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