Role of neurosonography in neonates with clinically suspected intracranial pathology

Abstract

Background: Preterm neonates have a higher mortality and morbidity because of their greater risk for intracranial hemorrhage (ICH), hypoxic ischemic encephalopathy(HIE) which can lead to poor neurodevelopmental outcomes. The present study was conducted to evaluate neonates with clinically suspected intracranial pathology by neurosonography.Methods: Included neonates were those with clinically suspected intracranial pathology admitted to neonatal intensive care unit of the Bharati Vidyapeeth Medical College and Hospital (Deemed to be University), Sangli from October 2018 till December 2018. First cranial neurosonography was done between first and third day, second between 7th and 10th day of birth. HIE also known as Periventricular leukomalacia (PVL) grading was done using the De Varies et al, grading. Severity of ICH was graded according to Papile and Burstein classification(1978).Results: Of the total 60 neonates, 61.7% were preterm and rest at term. Mean APGAR score at 1 minute was 8.6 (range 5 to 10) and at 5 minutes was 9.58 (range 8 to 10). Mean ventricular index at the first assessment was 26.78% and 26.89% at the second assessment. Grade 1 HIE was found in 17 neonates on first assessment, and two had grade 2 HIE. Second assessment revealed grade 1 HIE in 20 neonates and grade 2 in two. First assessment revealed two neonates with grade 1 and grade 2 ICH, out of which one grade 2 ICH worsened to grade 3. Two neonates were found to have corpus callosal agenesis.Conclusions: Transcranial neurosonography stands as an excellent and reliable investigation of choice for neonates to detect HIE,ICH and intracranial congenital anomalies.

Role of Neurosonography in Critically Ill Neonates in NICU

“…In neonates, fontanels and the many other suture lines remain unfused and act as a window for visualizing the inner brain maturation and pathological abnormalities. [1][2][3] Neurosonography plays an important role in critically ill neonates for regularly assessing the neonatal brain. It can identify most of the ischemic, hemorrhagic, cystic, and infective brain lesions and other severe structural abnormalities.…”

“…It is also useful in the timely detection of the causative factors of seizures and neonatal encephalopathy and then be used for sequential monitoring of hypoxic-ischemic brain damages. [2][3][4] In critically ill neonates with hypoxic-ischemic encephalopathy (HIE) and congenital or acquired brain anomalies, NUSG helps in assessing the gravity of neurodevelopment and its outcomes. [3][4][5][6] After birth, an NUSG can be used for screening of neonatal brain if clinically indicated.…”

“…[2][3][4] In critically ill neonates with hypoxic-ischemic encephalopathy (HIE) and congenital or acquired brain anomalies, NUSG helps in assessing the gravity of neurodevelopment and its outcomes. [3][4][5][6] After birth, an NUSG can be used for screening of neonatal brain if clinically indicated. The aim of the study was to use neurosonography to detect central nervous system (CNS) abnormalities in critically ill neonates as early as possible.…”