The most useful cranial ultrasound predictor of neurodevelopmental outcome at 2 years for preterm infants

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To determine the most important cranial ultrasound predictors of abnormality associated with neurodevelopmental outcome at 2 years of age in preterm infants. A total of 343 preterm infants born between 2005 and 2010 and cared for in KK Women's and Children's Hospital, a tertiary paediatric hospital, with birth weight ≤1,250 g were assessed in this retrospective study. Serial cranial ultrasound examinations were examined for intraventricular haemorrhage and cystic periventricular leukomalacia. Ventricular-brain ratio on term equivalent cranial ultrasound was measured. Neurodevelopmental outcome was assessed by the performance on Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III) at 2 years corrected age. Mental delay was defined as having a combined Bayley-III score (the average of cognitive and language scores) <80. The mean cognitive, language, and motor scores on Bayley-III in this cohort were 93±15, 83±18, and 92±15, respectively. Twenty-six percent of the preterm infants had mental delay and 4% had cerebral palsy. Ventricular-brain ratio >0.35 was the most significant factor associated with mental delay (odds ratio 5.28, 95% CI: 1.49-18.71, p=0.01). Other significant risk factors for mental delay were male gender, postnatal steroids, and necrotising enterocolitis, whereas maternal tertiary education was a protective factor against adverse outcome. Ventricular-brain ratio >0.35 on term-equivalent cranial ultrasound in preterm infants is the strongest predictor for mental delay on Bayley score at 2 years of age.