Role of Neurosonography in evaluation of brain abnormalities in neonates

Abstract

Background: Brain damage in preterm infants may result from a series of eventsrather than one specific insult. Maturational characteristics with a failingadaptation capacity may predispose the brain to harmful events during bothintrauterine and extrauterine life. The study aimed to detect anomalies in the brain of neonates with neurosonography. Methods : the studywas conducted on patients with clinically suspected lesions in the brain, undergoing NSG for evaluation of brain abnormalities in Prathima Institute ofmedical sciences, Karimnagar.Neurosonographic examinations were performed through anteriorfontanelle in both the coronal and sagittal planes.The examination started in the coronal plane along the coronal suture, with a transducer angled towards the frontal region. Then brain was examined invarious coronal planes by sweeping the transducer from anterior to posterior. Results : The most common abnormality found on neurosonogram in 3 – 5 days was germinal- matrix haemorrahge comprising n=13 (31%) followed by PVL n=12 (28.6%), cyst n=5 (11.9%), flaring n=5 (11.9%), cerebral edema n=4 (9.5%), congenital lesions n=2 (4.8%) and infections n=1 (2.4%). Follow up scan was performed around 2nd week of life, n=24 (57.1%) neonates were showing normal neurosonogram findings, remaining 18 (43%) showing abnormal findings, which are PVL n=6 (14.3%), GMH n=9 (21.4%), cyst n=1(2.4%), cerebral edema n=1 (2.4%) and congenital lesions n=1 (2.4%). Conclusion: High incidence of brain injuries was detected in babies born less than 32 weeks of gestation, weighing less than 1500 gm. The commonest clinical presentation was seizures followed by absent suckling and lethargy. The abnormalities found on the neurosonogram in our study were germinal matrix hemorrhage, periventricular leukomalacia, cystic PVL, corpus callosum agenesis, and TORCH infection.The mortality rate was high in grade III and grade IV GMH.10-14 days followup scan detected new cases of cystic PVL which were not diagnosed in the initial scan