Predictive Value Of Continuous Cranial Ultrasound For The Neurodevelopmental Outcomes Of Very Preterm Infants With Brain Injury

Objective:This study aimed to utilize sequential cranial ultrasound(cUS)for the assessment of the characteristics of cerebral ultrasound,brain injuries of very preterm infants.This study also aimed to investigate the relationship between cUS variables and the neurodevelopmental outcomes of the infants.Methods:Very preterm infants of gestational age(GA)? 28 weeks that were admitted to the neonatal intensive care unit of Hunan children's hospital between January 2012 and November 2014 were assessed for brain maturation and brain injury through cUS and MRI.Serial cUS(i.e.,weekly before discharge and monthly after discharge)was performed on very preterm infants(gestational age ? 28 weeks)until 6 months or older.Magnetic resonance imaging(MRI)was performed on the infants at approximately the term-equivalent age(TEA).The serial cUS and MRI at TEA were classified as grades 1 to 3.The mental developmental index(MDI)and psychomotor developmental index(PDI)were followed up until the infants were 20 months or older.The relationship between ultrasonic grades,brian injury and MDI/PDI scores was analyzed.The relationship between primary imaging and late imaging was analyzed.Results:First cUS:grade 1 of 6 cases(4.6%);grade 2 of 98 cases(76%);grade 3 of 25 cases(19.4%).Hemorrhage:germinalmatrix-intraventricular hemorrhage(GMH-IVH)in 27 cases,Pure choroid plexus bleeding in 22 cases,9 cases were accompanied with GMH-IVH hemorrhage.Late imaging:33 cases of hydrocephalus;31 cases of widened brain extralateral spaces.5 cases of intensive cystic periventricular leukomalacias(c-PVLs),4 cases of local c-PVLs.7 cases of subependymal cyst.The consistency rate between cUS and MRI was 88%.The degrees of GMH and PVE at the first cUS were significantly correlated with hydrocephaly but not significantly correlated with subependymal cyst.The PVE degree of the first cUS was significantly correlated with the widening of extracranial space.cUS classification has high sensitivity(more than 79%)for the prediction of MDI/PDI.Grades 3 and 4 GMH,GMH+CPH,PVE ?°,Extensive c-PVL,moderate and severe hydrocephaly were significantly correlated with MDI.GMH+CPH,Extensive c-PVL,moderate and severe hydrocephaly were significantly correlated with PDI.Conclusions:PVE-II is the most common cUS image in very premature infants.Infants with grades 3 and 4 GMH have very low survival rates and poorly developed brain nerves.cUS classification has high sensitivity for the prediction of CP.Dysplasia of the developing brain can result from cerebral hemorrhage,moderate and severe hydrocephaly,and extensive c-PVL.By contrast,the widening of the extralateral space,choroid plexus,and mild hydrocephaly have limited effects.Sustained,inhomogeneous echogenicity WM may suggest the presence of subtle WMI or local bleeding,which affects brain development.GMH is significantly correlated with the development of hydrocephaly but not with subependymal cysts and the widening of extralateral spaces.PVE degree is significantly correlated with the development of hydrocephaly and the widening of extralateral spaces but not with subependymal cysts.