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Cranial ultrasound reliably diagnoses many neonatal brain disorders. Adding Doppler imaging expands the spectrum by providing information on the status of the vasculature and haemodynamics that may guide further diagnostic and clinical management. Doppler imaging may identify neonates with congenital or acquired vascular abnormalities such as perinatal stroke, sinuvenous thrombosis, vein of Galen malformation, dural sinus malformation, sinus pericranii, and developmental venous anomaly. These entities may need further investigation with complementary imaging modalities such as magnetic resonance imaging and magnetic resonance angiography, or conventional angiography. This review aims to help clinicians to improve their Doppler sonography knowledge and skills in order to use this helpful tool in neonates with neurological symptoms or suspected cerebral vascular abnormalities admitted to the neonatal intensive care unit. [ABSTRACT FROM AUTHOR]

Neonatal ventriculomegaly often, but not always, follows intraventricular haemorrhage in infants born preterm. Serial cranial ultrasonography (CUS) is a very useful tool to evaluate the mechanism behind ventricular dilatation, to differentiate several types of cerebrospinal fluid retention, and to guide treatment. This review examines neonatal ventriculomegaly and its definition, pathophysiology, treatment, and prognosis from the perspective of CUS assessment. It also outlines the consensus statements formulated by the EurUS.Brain group, which are based on rounds of expert opinions on neonatal ventriculomegaly management, detailing the need and timing of ventricular access device placement, in the context of posthaemorrhagic ventricular dilation. The pathophysiology of neonatal ventriculomegaly is more complex than previously considered. CUS is a valuable, non‐invasive tool to determine pathophysiology, intervention thresholds, and prognosis in neonates with ventriculomegaly. Given new insights into the existence of glymphatics and water circulation in the cerebrum, further research in that area may bring new treatment options. What this paper adds: Cranial ultrasonography has a significant role in better understanding the complex pathophysiology of neonatal ventriculomegaly.The latest research suggests that treating posthaemorrhagic ventricular dilation in its early stages has several advantages.Proper definition, management, and a follow‐up plan are essential because they can impact the infant and their family, health care providers, educational systems, and society. [ABSTRACT FROM AUTHOR]

Aim: Our aim was to assess if term and preterm infants with volvulus showed different patterns with regard to pathogenesis, clinical presentation and outcome.Methods: We reviewed the medical records and imaging data of infants aged less than six months with volvulus treated in a single surgical referral centre from 2006-2013.Results: Volvulus was diagnosed in 19 infants, with no anatomical anomaly in three of the 12 preterm infants and one of the seven term infants. Most cases (74%) presented during the first eight days of life. Later presentations occurred exclusively in preterm infants, with only one of the five having no anatomic anomalies. Bilious vomiting was the leading symptom in six of the seven term infants, while the symptoms in preterm infants were rather nonspecific. Intestinal necrosis, with the need for bowel resection, occurred in one term (14%) infant and nine (75%) preterm infants.Conclusion: The clinical presentation and outcome of volvulus differed between preterm and term infants, but the rate and distribution of underlying anomalies did not differ. Symptoms in preterm infants were often nonspecific and led to a delay in diagnosis. This might have contributed to the higher rate of intestinal necrosis in preterm infants. [ABSTRACT FROM AUTHOR]

In preterm infants, the germinal matrix is a common origin of hemorrhages during the first 7 days of life. Sonographically, germinal matrix hemorrhages present as subventricular echodensities evolving into pseudocysts. Similar lesions have been reported as incidental findings also beyond 7 days of life. They may result from vasculitis and ischemic infarction, rather than hemorrhage. To assess the occurrence, time course, and significance for neurodevelopment of such late germinal matrix hemorrhage-like lesions, we reviewed serial cerebral ultrasound examinations obtained in 86 sequentially admitted infants (gestational age <32 weeks or birth weight <1500 g). Neurodevelopment was assessed at 3 years (Bayley Scales of Infant Development). Nine infants had late isolated germinal matrix hemorrhage-like lesions. Their Psychomotor Development Index scores were significantly lower than that in infants without hemorrhage. Our results suggest that late isolated germinal matrix hemorrhage-like lesions are of clinical significance because of their notable incidence and association with neurodevelopmental outcome. [ABSTRACT FROM AUTHOR]

Aim: To investigate cerebral white matter (WM) abnormalities ( J Pediatr 2003; 143: 171) and diffuse and excessive high signal intensities (DEHSI), ( J Pediatr 1999; 135: 351) in a cohort of extremely preterm infants born in Stockholm during a 3-year period, using magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI). Methods: MRI at term-equivalent age was performed in 109 infants and DTI data were acquired in 54 infants. Survival rate in the entire cohort was 67%. Sixteen term-born healthy control infants were scanned for comparison. Results: No or mild WM abnormalities were seen in 86% of infants and 14% had moderate or severe WM abnormalities. DEHSI were seen in infants with all grades of white matter abnormalities and were present in 56% of infants. In the WM at the level of centrum semiovale, infants with any WM abnormalities or DEHSI had lower Fractional Anisotropy and higher Apparent Diffusion Coefficient compared with control infants. No significant differences in diffusion were seen in infants without DEHSI compared with the controls in this region. Compared with controls, the preterm infants had significantly altered diffusion in the corpus callosum. Conclusion: Only 14% of the extremely preterm infants had moderate or severe WM abnormalities on MRI. However, the incidence of DEHSI was high. In the DEHSI regions, changes in diffusion parameters were detected, indicating altered WM organization. [ABSTRACT FROM AUTHOR]

Aim: In response to the disappointing outcome data of the population-based EPICure study published in 2000, we compared the outcome of infants 22 0/7 to 25 6/7 weeks of gestational age (GA) in a single tertiary care centre 2000–2004 with that of EPICure. Methods: EPICure tools and definitions, including 30 months’ Bayley Scales. Results: Of 83 infants <26 weeks born alive, more were admitted to intensive care – 82% vs. 68% (p < 0.0001) – and more infants survived to discharge (57% vs. 26%, p < 0.0001; 69% vs. 39%, p < 0.01, of those admitted to intensive care). More infants, as a percentage of live births, survived without severe (41%, 34/83 vs. 20%, 233/1185, p < 0.0001) or overall disability (22%, 18/83 vs. 13%, 155/1185, p = 0.03). However, at the border of viability – GA 23 and 24 weeks – the rate of infants surviving without overall disability was not significantly higher (13%, 6/45 vs. 9%, 56/623). Conclusion: In infants <26 weeks of GA, increased rates of survival and survival without disability were observed in a single-centre inborn cohort born 5–8 years later than the EPICure cohort. This did not translate into increased survival without overall disability in infants of 23–24 weeks of GA. [ABSTRACT FROM AUTHOR]

Abstract: Ventriculomegaly at term age is an important predictor of neurologic outcome in preterm infants. Previous studies have found only poor correlations between two-dimensional (2D) cranial ultrasound (US) measurements of lateral ventricles and volume measurements using three-dimensional (3D) magnetic resonance imaging (MRI). Paired cranial MRI and US scans in a population based cohort of 28 extremely preterm infants were obtained at term equivalent age. A 3D MRI volume and five different 2D ultrasound measurements were assessed for each lateral ventricle. Correlations and interobserver variability were calculated. Reliability of US measurements and correlations between MRI volumes and US measurements of the frontal horns and ventricular midbody were consistently good. The highest correlation was achieved by combining the coronal frontal horn measurements to a frontal horn product (r 2 = right 0.94, left 0.95). Our study underlines the value of cranial ultrasound measurements in neonatal care and follow-up. (E-mail: s.horsch@gmx.de) [Copyright &y& Elsevier]

Aim: We have shown previously that blood sampling via umbilical artery catheters decreases cerebral oxygenation and cerebral blood volume in preterm infants. To evaluate alternative methods, we assessed the effects of blood sampling via umbilical vein catheters in a cohort of preterm infants. Methods: Twenty neonates (median birth weight 900 g [range 410–1900 g], median gestational age 27 weeks [24–31 weeks]) were studied during routine blood sampling via umbilical vein catheters by near-infrared spectroscopy. Tissue oxygenation index and changes in concentrations of cerebral oxygenated and deoxygenated haemoglobin were measured and changes in cerebral oxygenation and cerebral blood volume were calculated. Oxygen saturation and heart rate were recorded simultaneously. Results: There was a significant drop of cerebral oxygenation (−2.135 ± 0.532 μmol/L) and cerebral blood volume (−0.037 ± 0.019 mL/100 g tissue) during umbilical vein blood sampling. Although peripheral arterial oxygen saturation remained unchanged, cerebral tissue oxygenation index decreased from 64.8 ± 2.5% to 62.4 ± 2.6% (p < 0.01), accompanied by a slight increase in heart rate (from 140 ± 2.9 to 144 ± 2.9 beats/min, p < 0.01). Conclusions: Umbilical vein blood sampling reduces cerebral oxygenation and cerebral blood volume. The magnitude of the effects is similar to those during umbilical artery blood sampling. [ABSTRACT FROM AUTHOR]

Aims: Brain abnormalities are common in preterm infants and can be reliably detected by magnetic resonance (MR) imaging at term equivalent age. The aim of the present study was to acquire population based data on brain abnormalities in extremely low gestational age (ELGA) infants from the Stockholm region and to correlate the MR findings to perinatal data, in order to identify risk factors. Methods: All infants with gestational age <27 weeks, born in the Stockholm region between January 2004 and August 2005, were scanned on a 1.5 T MR system at term equivalent age. Images were analysed using a previously established scoring system for grey and white matter abnormalities. Results: No or only mild white matter abnormalities were observed in 82% and moderate to severe white matter abnormalities in 18% of infants. The Clinical Risk Index for Babies (CRIB II) score, use of inotropes, the presence of high-grade intraventricular haemorrhages and posthaemorrhagic ventricular dilatation were associated with white matter abnormalities. Conclusion: The incidence of moderate to severe white matter abnormalities in a population-based cohort of ELGA infants from the Stockholm region was 18%. To examine the clinical relevance of these promising results, neurodevelopmental follow up at 30 month corrected age, is ongoing. [ABSTRACT FROM AUTHOR]

Background: Intraventricular haemorrhage and periventricular leukomalacia are associated with poor outcome of very preterm infants, while the role of more subtle cerebral alterations, as detected by cranial ultrasound, is less clear.Aim: In this study, we related periventricular echodensities and signs of brain atrophy to neurodevelopmental outcome at 3 y of age.Patients and Methods: All preterm infants born in 1997 in our institution with a gestational age <32 wk or birthweight <1500 g were subjected to repeated standardized cranial ultrasound examinations until discharge. Survivors were examined at 3 y of age employing the Bayley Scales of Infant Development II.Results: Eighty-seven infants were enrolled (birthweight 430-2500 g (median 1200 g), gestational age 24-34 wk (median 29 wk)). Periventricular echodensities were detected in 42 infants (48%); in 12 cases persisting <7 d, in 30 cases >7 d. At discharge, 18 infants (22%) had signs of brain atrophy. Neurodevelopmental outcome was assessed in 64 infants. Infants with signs of brain atrophy scored significantly lower on MDI (atrophy 91.8, no atrophy 101.9; p=0.02), PDI (atrophy 91.4, no atrophy 106.5; p=0.001) and Behaviour Rating Scale (atrophy 41.1, no atrophy 66.4; p=0.01) than infants without atrophy. Periventricular echodensities were not related to outcome.Conclusion: Our data show that infants with sonographic signs of brain atrophy at discharge achieve lower scores in neurodevelopmental testing at 3 y. [ABSTRACT FROM AUTHOR]

The thalamic nuclei develop before a viable preterm age. GABAergic neuronal migration is especially active in the third trimester. Thalamic axons meet cortical axons during subplate activation and create the definitive cortical plate in the second and third trimesters. Default higher‐order cortical driver connections to the thalamus are then replaced by the maturing sensory networks, in a process that is driven by first‐order thalamic neurons. Surface electroencephalographic activity, generated first in the subplate and later in the cortical plate, gradually show oscillations based on the interaction of the cortex with thalamus, which is controlled by the thalamic reticular nucleus. In viable newborn infants, in addition to sensorimotor networks, the thalamus already contributes to visual, auditory, and pain processing, and to arousal and sleep. Isolated thalamic lesions may present as clinical seizures. In addition to asphyxia and stroke, infection and network injury are also common. Cranial ultrasound can be used to classify neonatal thalamic injuries based on functional parcelling of the mature thalamus. We provide ample illustration and a detailed description of the impact of neonatal focal thalamic injury on neurological development, and discuss the potential for neuroprotection based on thalamocortical plasticity. [ABSTRACT FROM AUTHOR]

Neonates admitted to the intensive care unit are at risk of brain injury. Importantly, infants with signs of neurological impairment need prompt diagnosis to guide intervention. Cranial ultrasound (CUS) is the first‐line imaging tool for infants born preterm. New developments in this technology, which now incorporates high‐resolution equipment, have notably improved the performance of CUS in infants born at term and near‐term. On the other hand, the potential of CUS as a diagnostic tool in older infants is less established. The lack of studies focusing on this topic, local protocol variability among clinical sites, and divergent opinions on CUS patterns of disease entities are the main constraints. This review provides an overview of state‐of‐the‐art CUS as a decision‐making tool under different clinical scenarios, such as neonatal encephalopathy, seizures, and suspected central nervous system infection. The CUS features that characterize several patterns supporting a diagnosis are detailed, focusing on haemorrhage and infection. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 25-day-old preterm boy who was admitted to the hospital with complaints of apnea, abdominal distension and a firm mass in his left upper and lower abdomen. It mentions that his abdominal X-ray showed the sign of milk curd syndrome. It informs that laparotomy and colostomy was performed to remove the mass.

The article presents a case study of a 4-day-old monozygotic twin girls with asymmetrical crying facial appearance. Study shows that asymmetrical crying is caused by unilateral hypoplasia or aplasia of the depressor anguli oris muscle. It helps to distinguish the disorder from peripheral facial palsy. Furthermore, this case indicates a possible genetic origin thereby associated with abnormal conditions in the central nervous system including genitourinary and musculoskeletal system.

Background: Magnetic resonance imaging (MRI) is today the imaging modality of choice to investigate the neonatal brain. However, the acoustic noise during scanning is very loud, often exceeding 100 dBA. Aim: To reduce the acoustic noise during MRI for neonatal patients. If effective, this would create a safer environment and also result in fewer aborted examinations due to poor image quality from patient motion. Methods: A passive acoustic noise protector, the acoustic hood , was built out of dampening material. Sound pressure measurements with and without the acoustic hood were performed using our clinical neonatal scan protocol, consisting of eight imaging sequences. The acoustic hood is placed over the newborn inside the MR scanner tunnel during the examination to absorb acoustic noise. Results: The acoustic noise level was substantially reduced using the acoustic hood. Peak sound pressure was reduced 16.18–22.21 dBA depending on the pulse sequence. For the entire frequency spectra, reduction were between 4–13.59 dBA again varying with the pulse sequence. Conclusion: Acoustic noise can be reduced further than before by using the patient-independent acoustic hood in addition to other noise protection. We recommend the use of three passive hearing protections during neonatal MRI: (1) dental putty, (2) paediatric ear muffs, and (3) the acoustic hood. [ABSTRACT FROM AUTHOR]

In the absence of any overt task performance, it has been shown that spontaneous, intrinsic brain activity is expressed as system-wide, resting-state networks in the adult brain. However, the route to adult patterns of resting-state activity through neuronal development in the human brain is currently unknown. Therefore, we used functional MRI to map patterns of resting-state activity in infants during sleep. We found five unique resting-states networks in the infant brain that encompassed the primary visual cortex, bilateral sensorimotor areas, bilateral auditory cortex, a network including the precuneus area, lateral parietal cortex, and the cerebellum as well as an anterior network that incorporated the medial and dorsolateral prefrontal cortex. These results suggest that resting-state networks driven by spontaneous signal fluctuations are present already in the infant brain. The potential link between the emergence of behavior and patterns of resting-state activity in the infant brain is discussed. [ABSTRACT FROM AUTHOR]

The role of term-equivalent-age (TEA) cranial ultrasound (cUS) in predicting outcome in preterm infants is increasingly being recognized. However, a detailed quantitative scoring system that allows comparison of groups and comparison with TEA magnetic resonance imaging (MRI) scoring systems is lacking. Eighty-four extremely preterm infants underwent cUS and MRI at TEA. Cranial US was evaluated using a novel detailed scoring system. Agreement between cUS and MRI scores was good (Spearman's ρ = 0.51, p < 0.001). Outcome at 30 mo corrected was assessed in 66 of 84 preterm and 85 term-born infants. Sensitivity was the same for cUS and MRI in prediction of cerebral palsy (75%) and severe cognitive delay (100%); the specificity was slightly higher for MRI (cerebral palsy: 97% vs. 90%, severe cognitive delay: 95% vs. 90%). The proposed novel cUS scoring system is a helpful tool in quantitative assessment of cUS at TEA and prediction of outcome at 30 mo. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate clinical symptoms and findings on cranial ultrasound (CUS) in preterm infants with cerebellar haemorrhage through retrospective analysis of all preterm infants with a postnatal CUS or MRI diagnosis of cerebellar haemorrhage admitted in a tertiary care centre between January 2002 and June 2009. Fifteen infants were identified; median gestational age was 25 2/7 weeks and median birth weight 730 g. We discerned six types of haemorrhage: subarachnoid (n = 3), folial (n = 1), lobar (n = 9, of which 4 bilateral), giant lobar (n = 1, including vermis) and contusional (n = 1). Especially in infants with lobar cerebellar haemorrhage, CUS showed preceding or concurrent lateral ventricle dilatation, mostly without intraventricular haemorrhage (IVH). Thirteen infants suffered from notable, otherwise unexplained motor agitation in the days preceding the diagnosis. In conclusion, motor agitation may be a presenting symptom of cerebellar haemorrhage in preterm infants. Unexplained ventriculomegaly can be a first sign of cerebellar haemorrhage and should instigate sonographic exploration of the cerebellum. [ABSTRACT FROM AUTHOR]

Aim: Blood sampling from umbilical artery catheters decreases cerebral blood volume and cerebral oxygenation. The aim of this study was to assess the impact of sampling volume and velocity. Methods: Forty-eight infants, median birthweight 965 g (480–1500 g), median gestational age 27 wk (23–34 wk), were studied during routine blood sampling from umbilical artery catheters. The sampling procedure was performed following a strict protocol for draw-up volume (1.6 ml), sampling volume (1.7 ml or 0.2 ml), re-injection volume (1.6 ml) and flushing volume (0.6 ml), time of aspiration (40 s or 80 s), re-injection (30 s) and flushing (6 s). In each infant, sampling volume and aspiration time were subject to sequential variation in a randomized fashion (1.7 ml/40 s, 1.7 ml/80 s, 0.2 ml/30 s). Using near-infrared spectroscopy, changes in concentrations of cerebral oxygenated and deoxygenated haemoglobin were measured, and changes in cerebral blood volume and cerebral oxygenation were calculated. Results: During all three sampling procedures, oxygenated haemoglobin decreased significantly from baseline, whereas deoxygenated haemoglobin did not change. Correspondingly, a decrease in cerebral blood volume and cerebral oxygenation occurred. This decrease was not affected significantly by extending the sampling time from 40 s to 80 s, whereas it was blunted by reducing the amount of blood withdrawn. Conclusion: Blood sampling from umbilical artery catheters induces a decrease in cerebral blood volume and cerebral oxygenation. The magnitude of the decrease depends on the blood volume withdrawn but not on sampling velocity. [ABSTRACT FROM AUTHOR]