Cranial Ultra-sonographic Findings in Preterm Low Birth Weight and Very Low Birth Weight Infant

Abstract

Introduction: Preterm infants are at high risk of developing brain injury like germinal layer hemorrhage (GLH), intraventricular hemorrhage (IVH), hemorrhagic parenchymal infarction (HPI), cystic periventricular leukomalacia and diffuse non cystic white matter (WM) injury. Cranial ultrasound has been widely used in neonates for early detection of intra-cranial abnormalities which is convenient, non-invasive and safe, without radiation exposure. Early recognition and proper measurement can reduce neonatal mortality and morbidity. Objective: To find out cranial ultra-sonographic features of preterm neonate for proper evaluation and
management of CNS complication. Methodology: This prospective study was carried out from May/13 to Feb/14 in Neonatal Care Unit of Pediatrics department of SSMC & Mitford Hospital. Sixty preterm LBW and VLBW newborns were included by purposive sampling method. All newborns were clinically evaluated at 4th day and at two weeks of life; cranial ultrasonography was done by qualified sinologist. Anterior fontanel was used as acoustic window and thorough examination of brain and ventricles were done in coronal, sagittal and parasagittal plane. Result: Among 60 preterm newborns 35(58%) were LBW and 25(42%) were VLBW. Abnormalities in cranial initial Ultrasonography were found in 4(11.4%) cases at day four in LBW neonate and 9(36%) cases among VLBW neonate. Of them, sub ependymal hemorrhage 1(1.6%) case of LBW, intraventricular hemorrhage 3(5%) cases in VLBW, mild ventricular dilatation 7(11.6%) cases in both groups, moderate and marked dilatation occurred in 1(1.6%) cases and 1(4%) in LBW and VLBW group respectively. After 2 weeks 22(36.33%) newborns had abnormal cranial sonography. Majority 12(20%) had mild ventricular dilatation, followed by moderate and marked dilatation 2(3%) and 3(5%) cases respectively. Sub ependymal hemorrhage in 2(3.3%), Intraventricular hemorrhage was found in 3(5%) cases. Conclusion: This study concluded that Ultrasonography might be an important tool in early diagnosis of ICH in LBW infants which would help in optimum management to reduce mortality and subsequent morbidity.