Cranial Ultrasound Research Articles

Behavioral Deficits at 18-22 Months of Age Are Associated with Early Cerebellar Injury and Cognitive and Language Performance in Children Born Extremely Preterm

To investigate associations in toddlers born extremely preterm (<28 weeks) between neonatal neuroimaging and 18- to 22-month developmental and behavioral outcomes. Cohort analysis from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network Surfactant Positive Airway Pressure and Pulse Oximetry Trial Neuroimaging and Neurodevelopmental Outcomes Study of infants born extremely preterm. Subjects underwent cranial ultrasonography and near-term magnetic resonance imaging (MRI). At 18-22 months of corrected age, the assessment included the Brief Infant Toddler Social Emotional Assessment (BITSEA) Problem and Competence Scale scores and the Bayley Scales of Infant Development, Third Edition (Bayley-III). The BITSEA Problem Scale assesses dysregulation; the Competence Scale assesses social-emotional competence. We examined associations of Problem and Competence scores and positive screen rates with cranial ultrasonography and near-term MRI. Mean BITSEA and Bayley-III scores were compared using ANOVA and positive screen rates with the χ2 test. We computed correlations between BITSEA and Bayley-III scores. Of the 397 children, positive BITSEA screens were found in 34% for the Problem score and 26% for the Competence score. Presence of lesions on near-term MRI that included cerebellar lesions were significantly associated with lower BITSEA Competence but not with Problem scores; Competence scores were inversely related to the presence/significance of lesions. Positive screens on Competence scores and on both Competence and Problem scores were significantly associated with Bayley-III cognitive and language scores <85 (P < .001). Social-emotional competence contributes to deficits in cognitive and language development. Presence of injury on near-term MRI that includes cerebellar lesions is associated with later social-emotional competence and may be a useful predictor to guide early assessment and intervention. ClinicalTrials.gov: NCT00063063 and NCT00233324.

Point-of-care Cranial Ultrasound in a Hemicraniectomy Patient.

Point-of-care Cranial Ultrasound in a Hemicraniectomy Patient.

Health-related quality of life after post-haemorrhagic hydrocephalus in children born preterm.

To determine the health-related quality of life (HRQoL) of children born preterm (gestational age <32wks) after post-haemorrhagic hydrocephalus requiring shunt (PHH-S), and to examine the impact of perinatal and neurological morbidity on their QoL. Forty infants (18 females, 22 males; aged 2y 2mo-8y 4.5mo) born preterm with PHH-S were matched for gestational age, birthweight, and sex with infants born preterm with normal cranial ultrasonography. Pediatric QoL Inventory parent-proxy report was administered at a mean age of 5 years 8 months. Children with PHH-S exhibited significantly lower mean HRQoL compared with controls in motor (36 [SD 34.9] vs 96.2 [SD 6.6]), emotional (59.8 [SD 26.7] vs 80.6 [SD 18.8]), social (55.6 [SD 29.7] vs 89.6 [SD 16.6]), and school (40.5 [SD 22.9] vs 89.7 [SD 15.2]) domains (p<0.001). Multivariate regression incorporating neonatal risk factors revealed an independent effect of parenchymal brain involvement (β=-0.6, p<0.01) and neonatal seizures (β=-0.2, p<0.02) on total HRQoL. Low HRQoL of children with PHH-S was associated with neurodevelopmental morbidities: cerebral palsy (CP), epilepsy, vision and feeding problems, low cognitive, personal-social, and adaptive scores (p<0.05). Multivariate analysis indicated an independent contribution from severe CP (β=-0.4, p<0.001) and low personal-social score (β=0.5, p<0.001). Children born preterm after PHH-S exhibit significantly lower HRQoL scores compared with preterm born peers. HRQoL is associated with neonatal cerebral complications and neurodevelopmental morbidities. Children born preterm, after post-haemorrhagic hydrocephalus requiring shunt, have low health-related quality of life (HRQoL). A low HRQoL is associated with parenchymal brain involvement and with neurological morbidity. Severe cerebral palsy and low personal-social developmental scores have independent contributions to HRQoL.

Multiple subependymal pseudocysts in neonates play a role in later attention deficit hyperactivity and autistic spectrum disorder

To assess the long-term neurodevelopmental outcome of normal-term neonates who were accidentally found to exhibit subependymal pseudocysts (SEPCs), frontal horn cysts, or choroid plexus cysts through cranial ultrasound (CUS) examination in a neonatal health examination. In total, 5569 neonates received CUS examination as an item in a health examination during the first week of birth between 2002 and 2012. Among them, 5147 infants fulfilled the inclusion criteria. The participants were aged between 5 and 15yearsat the time when the data were collected. We retrospectively collected these data and interpreted their statistical significance by using one-way analysis of variance, Chi-square test with Yate's correction and odds ratios. The presence of SEPCs was significantly correlated with developmental delay and developmental disability, particularly with attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD). The risk of ADHD or ASD was significantly higher in participants with multiple SEPCs, among whom the odds ratios for ADHD and ASD were 6.50 (95% confidence interval [CI]=2.27-18.64) and 28.54 (95% CI=5.98-136.36), respectively, higher than those for the total study population. Our data revealed multiple SEPCs in normal-term neonates as a risk factor for neurobehavioral outcome, particularly in ADHD and ASD. Simultaneously, the utility of CUS examination as a health examination item for neonates was confirmed.

Practical guide to neonatal cranial ultrasound (CrUS): basics

Abstract Cranial ultrasonography is a reliable and readily available tool for neonatal brain imaging. It has become indispensable in the care of neonates as it helps to detect common congenital and acquired brain abnormalities. The use of modern ultrasound scan machines with the appropriate choice of probes, settings and acoustic windows has improved the diagnostic value of the cranial ultrasound in experienced hands. The standard acoustic window for imaging is the anterior fontanelle which is suitable for viewing the supratentorial structures. However, supplementary acoustic windows can be used for better visualisation of brain stem and posterior fossa structures. Doppler studies help to assess flow velocities in major vessels. Though cranial ultrasound has numerous advantages, it has some limitations. This article reviews the practical aspects of performing cranial ultrasound in a neonate.

Patterns of ischemic injury on brain images in neonatal group B Streptococcal meningitis.

Purpose This study investigated patterns of ischemic injury observed in brain images from patients with neonatal group B Streptococcal (GBS) meningitis.Methods Clinical findings and brain images from eight term or near-term newborn infants with GBS meningitis were reviewed.Results GBS meningitis was confirmed in all 8 infants via cerebrospinal fluid (CSF) analysis, and patients tested positive for GBS in both blood and CSF cultures. Six infants (75.0%) showed early onset manifestation of the disease (<7 days); the remaining 2 (25.0%) showed late onset manifestation. In 6 infants (75%), cranial ultrasonography showed focal or diffuse echogenicity, suggesting hypoxic-ischemic injury in the basal ganglia, cerebral hemispheres, and periventricular or subcortical white matter; these findings are compatible with meningitis. Findings from magnetic resonance imaging (MRI) were compatible with bacterial meningitis, showing prominent leptomeningeal enhancement, a widening echogenic interhemisphere, and ventricular wall thickening in all infants. Restrictive ischemic lesions observed through diffusion-weighted imaging were evident in all eight infants. Patterns of ischemic injury as detected through MRI were subdivided into 3 groups: 3 infants (37.5%) predominantly showed multiple punctuate lesions in the basal ganglia, 2 infants (25.0%) showed focal or diffuse cerebral infarcts, and 3 infants (37.5%) predominantly showed focal subcortical or periventricular white matter lesions. Four infants (50%) showed significant developmental delay or cerebral palsy.Conclusion Certain patterns of ischemic injury are commonly recognized in brain images from patients with neonatal GBS meningitis, and this ischemic complication may modify disease processes and contribute to poor neurologic outcomes.

Preterm infants with peri/intraventricular hemorrhage have poorer habituation responses to external stimuli

ObjectiveTo evaluate the association between intra-ventricular hemorrhage and habituation responses to external stimuli in preterm infants at 36–38 weeks post-conceptual age. MethodsCross-sectional study of infants with gestational age <32 weeks. Intra-ventricular hemorrhage was identified by cranial ultrasonography and classified according to Papile et al. (1978). The luminous (flashlight), sound (rattle, bell), and tactile stimuli were presented, and the responses were scored according to Lester and Tronik (2004). Habituation response scores were compared between groups by Student's t-test. The association between IVH and habituation scores was evaluated by linear regression adjusted for GA, clinical severity score, post-conceptual age at habituation assessment, sepsis, and bronchopulmonary dysplasia. ResultsSixty-five infants were studied, 20 with intra-ventricular hemorrhage (16 grades I/II; four grades III/IV) and 45 without intra-ventricular hemorrhage. Infants with intra-ventricular hemorrhage had lower gestational age (28.2±2.2 vs. 29.7±1.7 weeks) and birth weight (990±305 vs. 1275±360g). Infants with intra-ventricular hemorrhage at 36–38 weeks post-conceptual age had lower habituation scores to light (4.21±2.23 vs. 6.09±2.44), rattle (3.84±2.12 vs. 6.18±2.27), and bell (3.58±1.74 vs. 5.20±2.47) after controlling for confounders. No differences were found for tactile stimulus. ConclusionInfants with gestational age <32 weeks and intra-ventricular hemorrhage had poorer habituation responses to external stimuli than those without intra-ventricular hemorrhage at 36–38 weeks post-conceptual age.

Low-grade intraventricular hemorrhage and neurodevelopment at 24 months of age

AIMS: To evaluate the impact of low-grade intraventricular hemorrhage on neurodevelopmental outcome in preterm infants at 24 months of age.METHODS: We conducted a retrospective case-control study of infants with gestational age less than 34 weeks, admitted to a Neonatal Intensive Care Unit between January/2006 and December/2015. Cases were defined as those with low-grade intraventricular hemorrhage (grades I or II), diagnosed by cranial ultrasonography. For each case, a control with the same gestational age but without intraventricular hemorrhage was selected. Follow-up examinations of neurodevelopment were performed at 24 months of age in cases and controls using the Griffiths Mental Development Scale. Cerebral palsy, neurodevelopmental delay (developmental quotient &lt;2 side deviations below the mean), hearing impairment and/or blindness were considered as severe neurodevelopmental impairment.RESULTS: The study included 172 preterm infants: 86 cases and 86 controls. In the univariate analysis, a difference between the two groups was identified for the following clinical findings: antenatal corticosteroid complete cycle (57% in cases vs. 80% in controls; p=0.001; OR: 0.33, 95%CI 0.17-0.64); male gender (63% cases vs. 41% controls; p=0.004; OR: 2.45, 95%CI 1.3-4.5); outborn (26% cases vs. 9% controls; p=0.005; OR: 3.3 95%CI 1.4-8.0); Clinical Risk Index for Babies higher than 5 (24% in cases vs. 12% in controls; p=0.029; OR: 2.4 95%CI 1.1-5.6); intubation in the delivery room (47% cases vs. 27% controls; p=0.007; OR: 2.38 95%CI 1.3-4.5); and neonatal sepsis (34% in cases vs. 20% in controls; p=0.039; OR: 2.1 95%CI 1.03-4.1). After logistic regression, differences were only maintained for antenatal corticosteroid (p=0.005; OR 0.34, 95%CI 0.16-0.72) and male gender (p=0.002; OR 2.9, 95%CI 1.4-5.8). A severe neurodevelopmental deficit was present in three cases (3.5%) and one control (1.2%). No statistically significant differences in outcome were found between cases and controls.CONCLUSIONS: In this sample, preterm infants with low-grade intraventricular hemorrhage diagnosed by cranial ultrasonography had no difference in early neurodevelopmental outcome when compared with controls.

Cranial ultrasound and neurophysiological testing to predict neurological outcome in infants born very preterm.

Infants born preterm are at risk of cerebral palsy (CP) and motor or cognitive developmental delay. For clinicians, it is essential to know the relative predictive accuracy of the most commonly used neuroimaging and neurophysiological tests for the early prediction of adverse neurodevelopmental outcome. The aim of this study was to compare the accuracy of these tests in survivors of a population of infants born very preterm. A retrospective cohort study was performed in 163 children born before 32 weeks gestational age. We compared the accuracy in predicting adverse neurodevelopmental outcome at the age of 2 years 6 months of early and late cranial ultrasound (CUS), magnetic resonance imaging, somatosensory evoked potentials after stimulation of the posterior tibial nerve, and electroencephalography by calculating positive and negative likelihood ratios. An abnormal early CUS is the best predictor of the presence of CP (positive likelihood ratio 6.09), motor developmental delay (positive likelihood ratio 3.11), and cognitive developmental delay (positive likelihood ratio 5.66). Overall, negative likelihood ratios were poor, ranging between 0.49 and 0.98, meaning that a normal test result had only minimal influence on the probability of adverse neurological outcome. None of the diagnostic tests had a good performance in predicting future neurodevelopmental problems in infants born preterm. A normal test result provided very little clinically useful information. An abnormal early cranial ultrasound (positive test result) is the best predictor of adverse neurodevelopmental outcome. All negative results have poor predictive value of future neurodevelopmental problems.

Preterm Neuroimaging and School-Age Cognitive Outcomes.

Children born extremely preterm are at risk for cognitive difficulties and disability. The relative prognostic value of neonatal brain MRI and cranial ultrasound (CUS) for school-age outcomes remains unclear. Our objectives were to relate near-term conventional brain MRI and early and late CUS to cognitive impairment and disability at 6 to 7 years among children born extremely preterm and assess prognostic value. A prospective study of adverse early and late CUS and near-term conventional MRI findings to predict outcomes at 6 to 7 years including a full-scale IQ (FSIQ) <70 and disability (FSIQ <70, moderate-to-severe cerebral palsy, or severe vision or hearing impairment) in a subgroup of Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial enrollees. Stepwise logistic regression evaluated associations of neuroimaging with outcomes, adjusting for perinatal-neonatal factors. A total of 386 children had follow-up. In unadjusted analyses, severity of white matter abnormality and cerebellar lesions on MRI and adverse CUS findings were associated with outcomes. In full regression models, both adverse late CUS findings (odds ratio [OR] 27.9; 95% confidence interval [CI] 6.0-129) and significant cerebellar lesions on MRI (OR 2.71; 95% CI 1.1-6.7) remained associated with disability, but only adverse late CUS findings (OR 20.1; 95% CI 3.6-111) were associated with FSIQ <70. Predictive accuracy of stepwise models was not substantially improved with the addition of neuroimaging. Severe but rare adverse late CUS findings were most strongly associated with cognitive impairment and disability at school age, and significant cerebellar lesions on MRI were associated with disability. Near-term conventional MRI did not substantively enhance prediction of severe early school-age outcomes.

Automatic Segmentation of Neonatal Ventricles from Cranial Ultrasound for Prediction of Intraventricular Hemorrhage Outcome.

Intraventricular hemorrhage (IVH) followed by post hemorrhagic hydrocephalus (PHH) in premature neonates is one of the recognized reasons of brain injury in newborns. Cranial ultrasound (CUS) is a noninvasive imaging tool that has been used widely to diagnose and monitor neonates with IVH. In our previous work, we showed the potential of quantitative morphological analysis of lateral ventricles from early CUS to predict the PHH outcome in neonates with IVH. In this paper, we first present a new automatic method for ventricle segmentation in 2D CUS images. We detect the brain bounding box and brain mid-line to estimate the anatomical positions of ventricles and correct the brain rotation. The ventricles are segmented using a combination of fuzzy c-means, phase congruency, and active contour algorithms. Finally, we compare this fully automated approach with our previous work for the prediction of the outcome of PHH on a set of 2D CUS images taken from 60 premature neonates with different IVH grades. Experimental results showed that our method could segment ventricles with an average Dice similarity coefficient of 0.8 ± 0.12. In addition, our fully automated method could predict the outcome of PHH based on the extracted ventricle regions with similar accuracy to our previous semi-automated approach (83% vs. 84%, respectively, p-value = 0.8). This method has the potential to standardize the evaluation of CUS images and can be a helpful clinical tool for early monitoring and treatment of IVH and PHH.

Value of Cranial Ultrasonography and Resistive Index of Cerebral Arteries in Predicting Neuromotor Outcomes in Newborns with Hypoxic Ischaemic Encephalopathy

Value of Cranial Ultrasonography and Resistive Index of Cerebral Arteries in Predicting Neuromotor Outcomes in Newborns with Hypoxic Ischaemic Encephalopathy

Late neuroimaging predicts neurodevelopmental outcomes in preterm infants.

Commentary on: Hintz S, Barnes P, Bulas D, Slovis T, Finer N, Wrage L, et al. Neuroimaging and neurodevelopmental outcome in extremely preterm infants. Pediatrics 2015; 135: e32–42. Neurodevelopmental outcomes are a crucial part of prognosis and are pivotal in ongoing conversations between neonatologists and parents 1, 2. Recent studies show greater predictive value in near-term cranial ultrasound (CUS) and MRI versus traditional CUS performed in the first few weeks of life 1-3. MRI detects white matter injury more accurately while US detects intraventricular haemorrhages, ventriculomegaly and cystic periventricular leukomalacia 2, 4, 5. However, studies have found former preterm infants with developmental impairments despite normal NICU ultrasounds, and, importantly, others have reported transient findings of cystic periventricular leukomalacia (resolving by near-term) are associated with developmental impairments 2, 6, 7. The NEURO prospective study by Hintz et al. 8 analysed the predictive ability of early CUS, near-term CUS and near-term MRI in a cohort of 480 extremely preterm neonates, born at 24–27 weeks. Negative outcomes were defined as neurodevelopmental impairment, significant gross motor impairment or death. The authors provided multivariable modelling to consider perinatal and neonatal demographic and clinical risk factors. Results were presented as OR and AUC of ROC curves. Further statistical calculations of Tables 2–5 show sensitivity and specificity of 0.27 and 0.92, respectively, for the association between major findings in early CUS and negative outcomes of neurodevelopmental impairment or death, compared to sensitivity of 0.28 and specificity of 0.97 for major findings in late CUS. The calculated sensitivity and specificity of MRI WMA are similar to that reported by Woodward et al. 4 in 2006 (92% vs 84% and 23% vs 34%, respectively), demonstrating that MRI has potential for higher sensitivity than CUS. The major findings of the NEURO study were that early CUS is not predictive of future neurodevelopmental outcomes, despite taking into account perinatal and neonatal demographic and clinical risk factors. The ability to predict outcomes is only mildly enhanced by the addition of MRI to late CUS. Therefore, in environments where MRI is not easily available, late CUS may be sufficient in predicting prognosis. The strengths of the NEURO study included large population size, blinded imaging evaluations, required temporal proximity of late CUS and MRI. Limitations included that CUS was obtained by local centre protocol with possibility for technical inconsistencies, and there were low rates of adverse outcomes, leading to wide confidence intervals. While multivariable modelling taking into account neonatal risk factors scrutinises results, a drawback is potential over-analysis. Near-term CUS and MRI have been shown to be more reliable alternatives to early CUS in predicting outcomes, but imaging is only mildly effective in formulating predictions of neurodevelopmental outcomes in extremely premature neonates 2, 4, 9. There is still considerable uncertainty regardless of imaging modality or combination of imaging modalities used. Studies have shown that MRI before discharge is too early to detect posterior limb internal capsule myelination abnormalities, which have been shown to be associated with gross motor deficits 3, 5. Extending outcomes to include cognitive and behavioural difficulties of school-age ex-premature neonates will detect deficits not fully appreciated on Bayley or GMFCS testing 2, 9. https://ebneo.org/2018/06/late-neuroimaging-predicts-neurodevelopmental-outcomes-in-preterm-infants/ None. None.

Evaluation of Ventricle Size Measurements in Infants by Pediatric Emergency Medicine Physicians.

The identification of hydrocephalus in infants by pediatric emergency medicine (PEM) physicians using cranial point-of-care ultrasound (POCUS) has not been evaluated. We aimed to conduct a pilot/proof-of-concept study to evaluate whether PEM physicians can identify hydrocephalus (anterior horn width >5 mm) in 15 infants (mean 69 ± 42 days old) from the neonatal intensive care unit using POCUS. Our exploratory aims were to determine the test characteristics of cranial POCUS performed by PEM physicians for diagnosing hydrocephalus and the interrater reliability between measurements made by the PEM physicians and the radiologist. Depending on the availability, 1 or 2 PEM physicians performed a cranial POCUS through the open anterior fontanel for each infant after a 30-minute didactic lecture to determine the size of the left and right ventricles by measuring the anterior horn width at the foramen of Monroe in coronal view. Within 1 week, an ultrasound (US) technologist performed a cranial US and a radiologist determined the ventricle sizes from the US images; these measurements were the criterion standard. A radiologist determined 12 of the 30 ventricles as hydrocephalic. The sensitivity and specificity of the PEM physicians performed cranial POCUS was 66.7% (95% confidence interval [CI], 34.9%-90.1%) and 94.4% (95% CI, 72.7%-99.9%), whereas the positive and negative predictive values were 88.9% (95% CI, 53.3%-98.2%) and 81.0% (95% CI, 65.5%-90.5%), respectively. The interrater reliability between the PEM physician's and radiologist's measurements was r = 0.91. The entire POCUS examinations performed by the PEM physicians took an average of 1.5 minutes. The time between the cranial POCUS and the radiology US was, on average, 4 days. While the PEM physicians in our study were able to determine the absence of hydrocephalus in infants with high specificity using cranial POCUS, there was insufficient evidence to support the use of this modality for identifying hydrocephalus. Future studies with more participants are warranted to accurately determine test characteristics.

Postnatal Brain Growth Assessed by Sequential Cranial Ultrasonography in Infants Born

Brain growth in the early postnatal period following preterm birth has not been well described. This study of infants born at <30 weeks' gestational age and without major brain injury aimed to accomplish the following: 1) assess the reproducibility of linear measures made from cranial ultrasonography, 2) evaluate brain growth using sequential cranial ultrasonography linear measures from birth to term-equivalent age, and 3) explore perinatal predictors of postnatal brain growth. Participants comprised 144 infants born at <30 weeks' gestational age at a single center between January 2011 and December 2013. Infants with major brain injury seen on cranial ultrasonography or congenital or chromosomal abnormalities were excluded. Brain tissue and fluid spaces were measured from cranial ultrasonography performed as part of routine clinical care. Brain growth was assessed in 3 time intervals: <7, 7-27, and >27 days' postnatal age. Data were analyzed using intraclass correlation coefficients and mixed-effects regression. A total of 429 scans were assessed for 144 infants. Several linear measures showed excellent reproducibility. All measures of brain tissue increased with postnatal age, except for the biparietal diameter, which decreased within the first postnatal week and increased thereafter. Gestational age of ≥28 weeks at birth was associated with slower growth of the biparietal diameter and ventricular width compared with gestational age of <28 weeks. Postnatal corticosteroid administration was associated with slower growth of the corpus callosum length, transcerebellar diameter, and vermis height. Sepsis and necrotizing enterocolitis were associated with slower growth of the transcerebellar diameter. Postnatal brain growth in infants born at <30 weeks' gestational age can be evaluated using sequential linear measures made from routine cranial ultrasonography and is associated with perinatal predictors of long-term development.

Trial of life: Well infants presenting more than 24 h after head injury with a scalp haematoma: A 10-year review.

To review the investigation, patterns of injury and short-term outcomes of infants younger than 12 months of age who presented more than 24 h after head injury with an isolated scalp haematoma. A retrospective chart review of infants who presented with a head injury to the emergency department of a major paediatric hospital between 2006 and 2016. Patients were included if they presented more than 24 h after the injury, were clinically well and had a documented scalp haematoma. Charts were abstracted using a standardised instrument to yield patient characteristics, mechanism of injury, imaging performed, identified injuries and patient outcome. A total of 2433 records were reviewed, with 157 included in the study. The mean age was 7.5 months (standard deviation 2.6). Of the patients, 14 had a documented palpable skull fracture; 43 patients had a skull X-ray reported as a fracture; 13 patients had cranial ultrasounds with 3 reported as having a fracture; 124 patients had computed tomography head imaging, with 112 demonstrating a fracture; and 52 patients had acute intracranial abnormalities. There were nine unplanned representations (5.7%). No patients required any neurosurgical intervention. Infants presenting after 24 h with isolated scalp haematomas had good short-term outcomes despite a high prevalence of underlying injury on imaging. Expectant management, rather than imaging, may be a valid approach in this patient population. However, some of these injuries may have been the result of inflicted injury, and all of these patients require a robust assessment regardless of the decision to use a computed tomography scan.

Macrocephaly diagnosed during well child visits.

The measurement of head circumference (HC) provides valuable anthropometric data for a child's growth during well child visits. There are few studies on the characteristics of macrocephaly (MC) diagnosed during well child visits. The aim of this study was to identify the characteristics of children with MC diagnosed during the well-child visits. This descriptive clinical study was carried out in the well child unit of a medical faculty hospital. The health records of all children who were followed up between 2004 and 2014 were reviewed. The records of children with the diagnosis of MC were evaluated. All children with MC had cranial ultrasonography, measurement of parental HC, and biochemistry. The HC measurements were carried out until 3years of age in the unit. Ninety of 9,758 children (0.9%) had the diagnosis of MC. Of these children, 61% were male. Mean age at diagnosis was 2.7months. The majority of children (63.3%) had familial MC. The other leading findings were isolated MC and hydrocephalus: two of eight children with hydrocephalus had delayed neuromotor development. MC was not rare in the present well child unit population. The evaluation of parental HC and cranial ultrasonography might be important for the differential diagnosis.

STUDY OF CRANIAL ULTRASOUND FINDING IN HYPOXIC ISCHEMIC ENCEPHALOPATHY IN TERM INFANTS AND ITS CLINICAL CORELATION

Introduction: Incidence of Hypoxic Ischemic Encephalopathy (HIE) is 2-4 per 1000 live birth in USA, 1.8 per 1000 live births in Sweden, 3.8 per 1000 term live births in Australia. In India the incidence of HIE is 10-15 per 1000 live birth. The survivors from severe HIE develop cerebral palsy and mental handicaps as high as 50%. Concurrent use of cranial ultra sound and clinical staging systems are evolving to predict the prognosis. Objective: To study the cranial ultrasonogrphic finding in HIE Infants and its clinical correlation and prediction of outcome. Method: it is a prospective clinical study of 120 baby suffering from hypoxic ischemic encephalopathy. Result: Co-relation of initial cranial ultra sonography grading with mortality and sequel showed an increasing trend as the ultrasonography grading increases, with 51.4% mortality in grade –III, 18.5% in grade-II and 15.4% in grade –I. Seqele 48.6% was observed only in grade-III sonographic abnormality. Conclusion: Sonographic grading is more accurate than the clinical staging in predicting recovery, mortality and sequel.

Cranial ultrasonography and doppler in neonates: an observational study

Background: The CUS and transcranial doppler sonography is an emerging technique used in neonatal intensive care unit. It is noninvasive, ionizing, portable, safe and inexpensive for serial and long-term studies. Objectives of this study were to study intracranial abnormalities in neonates using ultra sonography on 3rd and 7th day of life and to study ACA blood flow velocity and RI (Resistive index) in neonates on 3rd and 7th day of life.Methods: It was a prospective observational study conducted on 229 neonates at NICU, Department of Pediatrics, Dr. D. Y. Patil Hospital and Research Institute, Kolhapur. During August 2015 to August 2017. After obtaining Informed consent from the parents/guardian details were recorded in a pre-designed pretested, structured proforma. Detailed clinical examination and Cranial ultrasound and doppler evaluation was performed on 3rd and on 7th post-natal day.Results: In the present study, out of 229 study participants, 65.5% were preterm, 34.5% were term. 67.2% had abnormal CUS findings. The PVHE, ICH, PVL, cyst and edema were common cranial abnormalities. These were statistically significant on 3rd day with gestational age, birth weight, low APGAR Score. Out of 229 neonates 58.9% had low, 35.3% normal and 5.8% had high RI index. Statistically significant association was found between gestational age, birth weight and APGAR score. Doppler analysis done on 3rd and 7th day showed rise in systolic and diastolic velocities regardless of the gestational age.Conclusions: Study concludes that CUS and Doppler is an ideal tool to detect various intracranial lesions efficiently in non-invasive manner.

Predictive Value of Cranial Ultrasound for Neurodevelopmental Outcomes of Very Preterm Infants with Brain Injury.

Background:Compared with full-term infants, very preterm infants are more vulnerable to injury and long-term disability and are at high risk of death. The predictive value of ultrasound and imaging on the neurodevelopment is one of the hot topics. This study aimed to investigate the relationship between cranial ultrasound (cUS) variables and neurodevelopmental outcomes of very preterm infants.Methods:Totally 129 very preterm infants (gestational age ≤28 weeks) in neonatal intensive care unit of Hunan Children's Hospital between January 2012 and November 2014 were included in this retrospective study. Serial cUS (weekly before discharge and monthly after discharge) was performed on the infants until 6 months or older. Magnetic resonance imaging (MRI) was performed on the infants at approximately the term-equivalent age. The mental developmental index (MDI) and psychomotor developmental index (PDI) were followed up until the infants were 24 months or older. The relationship between brain injury and MDI/PDI scores was analyzed.Results:The consistency rate between cUS and MRI was 88%. At the first cUS, germinal matrix hemorrhage (GMH) Grades 3 and 4, hospitalization duration, and weight are significantly correlated with MDI/PDI and prognosis (MDI: odds ratio [OR] = 8.415, 0.982, and 0.042, P = 0.016, 0.000, and 0.004; PDI: OR = 7.149, 0.978, and 0.012, P = 0.025, 0.000, and 0.000, respectively). At the last cUS, gestational age, extensive cystic periventricular leukomalacia (c-PVL), and moderate and severe hydrocephaly are significantly correlated with MDI (OR = 0.292, 60.220, and 170.375, P = 0.004, 0.003, and 0.000, respectively). Extensive c-PVL and moderate and severe hydrocephaly are significantly correlated with PDI (OR = 76.861 and 116.746, P = 0.003 and 0.000, respectively).Conclusions:Very premature infants with GMH Grades 3 and 4, short hospitalization duration, and low weight have low survival rates and poorly developed brain nerves. Cerebral palsy can result from severe cerebral hemorrhage, moderate and severe hydrocephaly, and extensive c-PVL. The sustained, inhomogeneous echogenicity of white matter may suggest subtle brain injury.