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.

Brain structure development of very pre-term infants on serial cranial ultrasound

To the Editor:Survival rates for very pre-term infants have risen drastically in recent years owing to successful assistedventilation techniques;the latest prenatal and postnatal treatments;and modern,well-equipped,and well-staffed neonatal intensive care units?1Cranial ultrasound(cUS)is the primary imaging technique for evaluating brain injury in very pre-term infants.Very pre-term infants have several unique features related to their ongoing maturation,and associated findings on cUS should be considered for accurate and early diagnosis.13,41 The purpose of this study was to summarize the cUS characteristics of the brains of very premature infants of different gestational ages(GAs)<29 weeks to provide an understanding of the diagnosis of abnormal brain conditions.