Abstract
Aims and Objectives: To determine the frequency of cranial ultrasound abnormalities in preterm neonates in the first week of life. To evaluate the association between cranial ultrasound findings and perinatal risk factors in regard to the immediate clinical outcome. Materials and Methods: This Retrospective study was done in NICU in a tertiary hospital. Records of all preterm neonates (<37weeks) admitted to NICU who underwent neuro-sonography between Jan2016 – Jan2017 were included. Results: Out of 100 preterms, 53% had normal CUS findings while 47% had abnormal finding. Abnormal CUS was significantly associated with gestational age <32weeks (p<0.001) and birth weight <1.5kg (p=0.006).Among the abnormal CUS findings intraventricular hemorrhage was the most common (40.42%) followed by periventricular hyper-echogenicity (21.27%), cystic periventricular leukomalacia (8.51%), parenchymal bleed (8.51%), cysts (8.51%), cerebral edema (6.38%), ventriculomegaly (4.25%) and thalamic injury (2.12%). Neonatal comorbidities associated with abnormal cranial ultrasound were RDS (25.53%), neonatal sepsis (21.27%), birth asphyxia (17.02%), neonatal seizures (8.51%), NEC (6.38%) and others (21.27%). There was significant association between abnormal cranial ultrasound and RDS (p=0.014) and birth asphyxia (p=0.008). Mortality was 36.1% and all had abnormal cranial USG. Intraventricular hemorrhage (76.4%) was the most common cause of death followed by parenchymal bleed (11.7%). Conclusion: There was significant association between abnormal CUS and gestational age and birth weight. Most common abnormality was IVH and it carried the highest mortality. RDS and birth asphyxia had significant association with abnormal ultrasound. Early neurosonography could help in prognosticating immediate outcome and early intervention.
Highlights
Preterm neonates have increased risk of birth asphyxia, respiratory distress syndrome, temperature instability, hypoglycemia and sepsis [1]
Abnormal Cranial ultrasound (CUS) was significantly associated with gestational age
Table-1: Distribution according to gestational age and birth weight
Summary
Preterm neonates have increased risk of birth asphyxia, respiratory distress syndrome, temperature instability, hypoglycemia and sepsis [1]. Premature neonate is vulnerable to both hemorrhagic and ischemic brain injuries. This is due to vascular, cellular and anatomical feature of developing brain and physiological instability because of limited cerebral auto regulation [1,2]. Contributors to mortality and morbidity [3]. The mortality rates have fallen down due to improvement in obstetrics and neonatal intensive care, there is growing concern over adverse neuro developmental outcome. Almost 10-15% preterm neonates develop cerebral palsy while upto 50% have another adverse neurological outcome[4]. Germinal matrix hemorrhage (GMH) / Intraventricular hemorrhage (IVH) and white matter injury cystic periventricular leukomalacia (cPVL) are major
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