Brain Growth Evaluation Assessed with Transfontanellar (B-GREAT) Ultrasound. Old and New Bedside Markers to Estimate Cerebral Growth in Preterm Infants: a Pilot Study

Abstract

Objective: We aimed to investigate the feasibility of evaluating overall preterm brain growth using a gathered set of measurements of brain structures in standard cranial ultrasound planes. We called this method of assessment Brain GRowth Evaluation Assessed with Transfontanellar ultrasound (B-GREAT). Study design: In this prospective observational cohort study, cranial ultrasound was regularly performed (on day 1, 2, 3, 7 of life and then weekly until discharge and at term) in preterm infants born with a gestational age less than 32 weeks. We evaluated Corpus Callosum (CC) length, Corpus Callosum-Fastigium (CCF) length, Anterior Horn Width (AHW), Frontal White Matter (FWM) height, Total brain Surface (TBS), Deep Grey Matter (DGM) height, Hemisphere Height (HH), Transverse Cerebellar Diameter in the axial view (TCDax) and coronal view (TCDcor). Measurements obtained were used to develop growth charts for B-GREAT markers as a function of postmenstrual age. Reproducibility of B-GREAT markers was studied. Results: A total of 528 cranial ultrasounds was performed in 80 neonates (median birth gestational age: 28+5 weeks, interquartile range: 27+3 to 30+5). The intraclass correlation coefficients for intra-observer and inter-observer analyses showed substantial agreement for all B-GREAT markers. Growth curves for B-GREAT markers were developed. Conclusion: B-GREAT is a feasible and reproducible method for bedside monitoring of the growth of the main brain structures in preterm neonates.

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“…The final results showed that the scores were significantly correlated with gestational age. Notably, another method named B-GREAT for assessing brain growth in preterm infants was proposed by Arena and others [ 32 ]. This study involved 80 preterm infants born around 28 weeks of gestation who underwent a total of 528 CUS examinations.…”