Cranial ultrasound findings in late preterm infants and correlation with perinatal risk factors

Abstract

BackgroundLate preterm infants are the most represented premature babies. They are exposed to a wide spectrum of brain lesions which are often clinically silent, supporting a possible role of cerebral ultrasound screening. Aim of the study is to describe the pattern of cranial ultrasound abnormalities in late preterm infants and to define the need for cranial ultrasound according to perinatal risk factors.MethodsA hospital-based cranial ultrasound screening was carried out by performing two scans (at 1 and 5 weeks). Unfavorable cranial ultrasound at 5 weeks was defined as either persistent periventricular hyperechogenicity or severe abnormalities.ResultsOne thousand one hundred seventy-two infants were included. Periventricular hyperechogenicity and severe abnormalities were observed in, respectively, 19.6 % and 1 % of late preterms at birth versus 1.8 % and 1.4 % at 5 weeks. Periventricular hyperechogenicity resolved in 91.3 %. At the univariate analysis gestational age (OR 0.5, 95 % CI 0.32-0.77), Apgar score <5 at 5’ (OR 15.3, 1.35-173) and comorbidities (OR 4.62, 2.39-8.98) predicted unfavorable ultrasound at 5 weeks. At the multivariate analysis the accuracy in predicting unfavorable ultrasound, estimated by combined gestational age/Apgar/comorbidities ROC curve, was fair (AUC 74.6) and increased to excellent (AUC 89.4) when ultrasound at birth was included.ConclusionGestational age and comorbitidies are the most important risk factors for detecting brain lesions. The combination of being born at 34 weeks and developing RDS represents the strongest indication to perform a cranial ultrasound. Differently from other studies, twin pregnancy doesn’t represent a risk factor.

Late preterm births: New insights from neonatal neuroimaging and neurobehaviour

“…Several studies have reported cranial ultrasound findings in cohorts that include LP children. A single hospital study performed cranial ultrasound scans at 1 and 5 weeks in 1172 LP infants (34-36 weeks completed gestation) [12]. "Unfavourable" cranial ultrasound, defined as persistent periventricular hyperechogenicity, cysts, intraventricular haemorrhages, arterial strokes or venous malformations, were reported in 1.8% of cases at 5 weeks.…”

Study of cranial ultrasound its correlation with perinatal risk factors and its outcome in preterm neonates admitted to Neonatal intensive care unit

“…Most common abnormality was RDS (22%) followed by neonatal sepsis (20.33%) and birth asphyxia (13.5%). Fumagalli et al also observed increased risk of brain injury mainly IVH in preterm neonates with RDS as it has been associated with fluctuation of cerebral blood flow in the first few days of life [1]. Vermeulen et al reported early onset neonatal infectious disease as an independent risk factor for abnormal cranial USG [18].…”

“…Routine screening CUS in general are recommended for all infants born before 34 weeks gestational, but higher brain vulnerability in late preterm infants as compared to term babies is well known [1]. Early identification of late preterms with brain abnormalities at CUS would allow early intervention programme to improve longterm outcomes.…”

“…Preterm neonates have increased risk of birth asphyxia, respiratory distress syndrome, temperature instability, hypoglycemia and sepsis [1]. Premature neonate is also vulnerable to both hemorrhagic and ischemic brain injuries.…”

“…Premature neonate is also 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].…”