Neonatal cranial ultrasonography as predictor of 2 year outcome of very low birthweight infants

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Abstract
Real time ultrasound scans using an ATL 300C sector scanner with 5-7.5 MHz transducer were performed on days 1, 4, 7 and thereafter as clinically necessary on 153 consecutively discharged very low birthweight (VLBW) infants. One hundred and forty-six long-term survivors were assessed fully at 2 years. The prevalence of cerebroventricular haemorrhage (CVH) in these survivors was 34.2% (grade 1-21.2%; grade 2-4.8%; grade 3-3.4%; grade 4-4.8%), ventricular dilatation 19.9% (including 4.1% with ventriculoperitoneal shunt), and ischaemia 9%. Impairments at 2 years were classified as nil, mild, moderate, severe or multiply severe, based on the criteria of Kitchen et al. Overall, 120 infants (82.2%) were unimpaired and 6.2% had mild, 3.4% had moderate, 4.1% had severe and 4.1% had multiply severe impairment. The major factors associated with impairment were gestational age <28 weeks, birthweight < 1000 g, vaginal delivery, respiratory distress syndrome, mechanical ventilation, pulmonary air leaks and CVH. When these factors were reanalysed in a logistic regression model for odds ratio, only CVH (P < 0.005) and birth by spontaneous vaginal delivery (P < 0.05) was significant. The prevalence of impairment was 11.4% with no CVH, 6.5% grade 1,71% grade 2, 20.0% grade 3 and 100.0% grade 4 CVH. The sensitivity of CVH of grade 2 or greater as a screening test was 64.7% for impairment. 78.6% for cerebral palsy and 70% for severe intellectual handicap. The mean general quotient (GQ) (Griffiths) at 2 years for infants with CVH was 89.1 and 97.5 for those without CVH (P < 0.001). Although infants with ventricular dilatation had an average GQ that was 13.1 units less than those with normal ventricles, the difference was only significant in those with a CVH of grade 2-4. The study shows that sonographic diagnosis of CVH and ventricular dilatation, but not ischaemia, to be a useful adjunct in predicting impairment and intellectual performance in VLBW infants does not replace the need for multidisciplinary follow-up.