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Neurosonography

Cranial ultrasonography





Cranial ultrasonography (CUS) was introduced into neonatology in the late 1970s and has become an essential diagnostic tool in modern neonatology. The non-invasive nature of ultrasonography makes it an ideal imaging technique in the neonate. In the neonate and young infant, the fontanels and many sutures of the skull are still open, and these can be used as acoustic windows to "look" into the brain.

















Transfontanellar CUS allows the use of high-frequency transducers, with high near-field resolution. As a result of ongoing development in ultrasonography, image quality is high nowadays, provided optimal settings and techniques are applied.

Therefore, CUS is a reliable tool for detecting congenital and acquired anomalies of the perinatal brain and the most frequently occurring patterns of brain injury in both preterm and full-term neonates.










Purpose of ultrasound screening
  • To detect brain injury in at risk babies in order to provide appropriate medical management
  • To detect lesions associated with long-term adverse neurodevelopmental outcome
Indications for cerebral ultrasound
  • All infants equal or < 32 weeks gestation
  • When clinical situation of the infant deteriorates
  • Sudden drop in haemoglobin
  • Abnormal neurological signs (e.g. floppy child, large head)
  • Neonatal seizures
  • All infants with history consistent with hypoxic ischemic insult
  • NEC
  • Unexplaned poor feeding at term
  • Suspected malformations
 
Time scheduled

  • Following admission, as early as possible (if baby stable)
  • 1 week
  • 3 weeks
  • Around term
  • Predischarge                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
Indications for ultrasonography at term corrected age
  • Born prematurely, <32 weeks and /or birth weight <1500g
  • Periventricular flaring at discharge
  • Leukomalacia
  • Meningitis
Cranial ultrasounds are performed to look at problems of premature or complicated births.

These include swelling of the brain, bleeding n the brain (intraventricular haemorrhage, IVH), Periventricular Leucomalacia (PVL), and any structural problems.

IVH is more common in premature babies than in full-term infants. Cranial ultrasound can detect most cases of IVH at the first week after delivery. IVH is usually classified into 4 grades, depending on the severity of the bleeding. A grade 1 or 2 bleed has a better outcome for the baby than a grade 3 or 4 bleed.














Fig. 1. Bilateral Grade 3 GM IVH.
By contrast, PVL can take several weeks to develop. In PVL the brain tissue around the ventricles is damaged, possibly from decreased oxygen or blood flow to the brain that may have occurred before, during, or after delivery. Several cranial ultrasound tests may be done to evaluate suspicious areas in the brain.


   

Fig. 2. Ultrasound scan in a premature infant who gradually, over a period of weeks, developed extensive  cystic leukomalacia (grade 4)
From January 2011 in a frame of the "Improving Neonatal Care in Armenia" project, with the support of VivaCell МТС and Birthlink, Reserch Center of Maternal and Child Health Protection started high risk newborns cranial  ultrasound in neonatal units of Yerevan and district maternities. Newest model of ultrasound machine "Zonare" (Z.one ultra Convertible Ultrasound Systems) will be used. Portable module of the machine will be available for consultation.


 






























Screening will be done by head of neonatal unit RCMHP Dr. Pavel Mazmanyan.
Contact tel. (055) 41-65-89 и (010) 53-01-02
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