Search

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]

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]

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]

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]

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 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]