Role of neurosonography in neonates with clinically suspected intracranial pathology

Abhishek Gahlot, Anil Joshi


Background: Preterm neonates have a higher mortality and morbidity because of their greater risk for intracranial hemorrhage (ICH), hypoxic ischemic encephalopathy(HIE) which can lead to poor neurodevelopmental outcomes. The present study was conducted to evaluate neonates with clinically suspected intracranial pathology by neurosonography.

Methods: Included neonates were those with clinically suspected intracranial pathology admitted to neonatal intensive care unit of the Bharati Vidyapeeth Medical College and Hospital (Deemed to be University), Sangli from October 2018 till December 2018. First cranial neurosonography was done between first and third day, second between 7th and 10th day of birth. HIE also known as Periventricular leukomalacia (PVL) grading was done using the De Varies et al, grading. Severity of ICH was graded according to Papile and Burstein classification(1978).

Results: Of the total 60 neonates, 61.7% were preterm and rest at term. Mean APGAR score at 1 minute was 8.6 (range 5 to 10) and at 5 minutes was 9.58 (range 8 to 10). Mean ventricular index at the first assessment was 26.78% and 26.89% at the second assessment. Grade 1 HIE was found in 17 neonates on first assessment, and two had grade 2 HIE. Second assessment revealed grade 1 HIE in 20 neonates and grade 2 in two. First assessment revealed two neonates with grade 1 and grade 2 ICH, out of which one grade 2 ICH worsened to grade 3. Two neonates were found to have corpus callosal agenesis.

Conclusions: Transcranial neurosonography stands as an excellent and reliable investigation of choice for neonates to detect HIE,ICH and intracranial congenital anomalies.


Low birth weight neonates, , Premature, Transcranial neurosonography, Ultrasonography

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O’Leary H, Gregas MC, Limperopoulos C, Zaretskaya I, Bassan H, Soul JS, et al. Elevated cerebral pressure passivity is associated with prematurity-related intracranial hemorrhage. Pediatri. 2009;124(1):302.

Bada HS, Hajjar W, Chua C, Sumner DS. Noninvasive diagnosis of neonatal asphyxia and intraventricular hemorrhage by Doppler ultrasound. J Pediatr. 1979;95(5.1):775-9.

de Assis MC, Machado HR. Intracranial blood flow velocities evaluated by color Doppler (duplex) in preterm infants. Arq Neuropsiquiatr. 2004;62(1):68-74.

Volpe JJ. Intracranial hemorrhage: germinal matrix- intraventricular hemorrhage of the premature infant. In: Volpe JJ (ed) Neurology of the newborn, 5th ed. Saunders, Philadelphia; 2008:517-588.

Bracci R, Perrone S, Buonocore G. The timing of neonatal brain damage. Neonatol. 2006;90(3):145-55.

Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress: a clinical and electroencephalographic study. Arch Neurol. 1976;33(10):696-705.

Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978;92(4):529-34.

Taylor GA. Doppler do cérebro no neonato e do lactente. In: Rumack CM, Wilson SR, Charboneau JW, editores. Tratado de ultra-sonografia diagnóstica. 3a ed. Rio de Janeiro, RJ: Elsevier; 2006:1703-22.

Burstein J, Papile L, Burstein R. Subependymal germinal matrix and intraventricular hemorrhage in premature infants: diag- nosis by CT. AJR Am J Roentgenol. 1977;128:971-6.

Ben‐Ora A, Eddy L, Hatch G, Solida B. The anterior fontanelle as an acoustic window to the neonatal ventricular system. J Clin Ultrasound. 1980;8(1):65-7.

London DA, Carroll BA, Enzmann DR. Sonography of ventricular size and germinal matrix hemorrhage in premature infants. Am J Roentgenol. 1980;135(3):559-64.

Bracci R, Perrone S, Buonocore G. The timing of neonatal brain damage. Biol Neonate. 2006;90:145-55.

Mancini MC, Barbosa NE, Banwart D, Silveira S, Guerpelli JL, Leone CR. Intraventricular hemorrhage in very low birth weight infants: associated risk factors and outcome in the neonatal period. Revista Hospital Clin. 1999;54(5):151-4.

Antoniuk S, da Silva RV. Periventricular and intraventricular hemorrhage in the premature infants. Rev Neurol. 2000;31(3):238-43.

Wildrick D. Intraventricular hemorrhage and long-term outcome in the premature infant. J Neurosci Nurs. 1997;29(5):281-9.