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Technique and reporting: arterial ischemic stroke. Top: term infant with focal seizures on day 2: left posterior truncal MCA stroke; ultrasound and MRI (diffusion weighted and T2) on day 3. Bottom: vaginal breech delivery at 36 weeks' GA, apnea, and tense fontanel at 24 h; pallor; and lowered consciousness: posterior cerebral artery stroke following uncal herniation due to right convexity subdural hematoma (left image on admission, other images on day 5) (arrow in the middle image: thalamic perforator stroke).
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In the past three decades, cerebral ultrasound (CUS) has become a trusted technique to study the neonatal brain. It is a relatively cheap, non-invasive, bedside neuroimaging method available in nearly every hospital. Traditionally, CUS was used to detect major abnormalities, such as intraventricular hemorrhage (IVH), periventricular hemorrhagic inf...
Context in source publication
Context 1
... with careful serial CUS imaging. 37 An increased parenchymal echogenicity that becomes more apparent the first days after the insult and an abnormal perfusion pattern (restricted or luxury perfusion) can be detected in the vascular territory involved. In case of a persisted occlusion, Doppler imaging of the affected vessel can be informative (Fig. ...
Similar publications
Neurosonography is an essential imaging modality for assessing the neonatal brain, particularly as a screening tool to evaluate intracranial hemorrhage, hydrocephalus and periventricular leukomalacia. The primary advantages of neurosonography include portability, accessibility and lack of ionizing radiation. Its main limitations are intrinsic opera...
Citations
... This radiation-free technique has been increasingly employed and is now the first-line neuroimaging modality to study the neonatal brain. In the NICU context, bedside cranial US studies can be serially performed with acceptable disturbance to the infant and do not require patient transport nor sedation [1,2]. The procedure provides quick images in real time and can be performed directly after birth [2]. ...
... In the NICU context, bedside cranial US studies can be serially performed with acceptable disturbance to the infant and do not require patient transport nor sedation [1,2]. The procedure provides quick images in real time and can be performed directly after birth [2]. ...
The quality of cranial ultrasound has improved over time, with advancing technology leading to higher resolution, faster image processing, digital display, and back-up. However, some brain lesions may remain difficult to characterize: since higher frequencies result in greater spatial resolution, the use of additional transducers may overcome some of these limitations. The very high-frequency transducers (18-5 MHz) are currently employed for small parts and lung ultrasound. Here we report the first case series comparing the very high-frequency probes (18-5 MHz) with standard micro-convex probes (8-5 MHz) for cranial ultrasound in preterm infants. In this case series, we compared cranial ultrasound images obtained with a micro-convex transducer (8-5 MHz) and those obtained with a very high-frequency (18-5 MHz) linear array transducer in 13 preterm infants ≤ 32 weeks gestation (9 with cerebral abnormalities and 4 with normal findings). Ultrasound examinations using the very high-frequency linear transducer and the standard medium-frequency micro-convex transducer were performed simultaneously. We also compared ultrasound findings with brain MRI images obtained at term corrected age. Ultrasound images obtained with the very high-frequency (18-5 MHz) transducer showed high quality and accuracy. Notably, despite their higher frequency and expected limited penetration capacity, brain size is small enough in preterm infants, so that brain structures are close to the transducer, allowing for complete evaluation.
Conclusion: We propose the routine use of very high-frequency linear probes as a complementary scanning modality for cranial ultrasound in preterm infants ≤ 32 weeks gestation.
What is Known:
• Brain lesions in preterm infants may remain insufficiently defined through conventional cranial ultrasound scan.
• Higher frequency probes offer better spatial resolution but have a narrower filed of exploration and limited penetration capacity.
What is New:
• Very high-frequency probes were compared with standard medium-frequency probes for cranial ultrasound in infants ≤ 32 weeks' gestation.
• Thanks to the smaller skull size of preterm infants, the new very high-frequency transducers allowed a complete and accurate evaluation.
... Ultrasound is the method of choice in neonatology because it is widely available, does not contain ionizing radiation, and does not require sedation. Neurosonography has become an affordable and reliable technique for detecting focal intracerebral lesions, including intraventricular hemorrhage, infarcts, and hydrocephalus [56]. However, the detection of diffuse processes that may result from perinatal asphyxia, such as white matter edema, is proving more difficult and appears to be more dependent on physician expertise and experience. ...
Brain injury resulting from adverse events during pregnancy and delivery is the leading cause of neonatal morbidity and disability. Surviving neonates often suffer long-term motor, sensory, and cognitive impairments. Birth asphyxia is among the most common causes of neonatal encephalopathy. The integration of ultrasound, including Doppler ultrasound, and near-infrared spectroscopy (NIRS) offers a promising approach to understanding the pathology and diagnosis of encephalopathy in this special patient population. Ultrasound diagnosis can be very helpful for the assessment of structural abnormalities associated with neonatal encephalopathy such as alterations in brain structures (intraventricular hemorrhage, infarcts, hydrocephalus, white matter injury) and evaluation of morphologic changes. Doppler sonography is the most valuable method as it provides information about blood flow patterns and outcome prediction. NIRS provides valuable insight into the functional aspects of brain activity by measuring tissue oxygenation and blood flow. The combination of ultrasonography and NIRS may produce complementary information on structural and functional aspects of the brain. This review summarizes the current state of research, discusses advantages and limitations, and explores future directions to improve applicability and efficacy.
... Extremely premature and extremely low birth weight infants are born at a critical time in brain maturation, and improving neurological development outcomes remains a challenge 14 . Tests to identify these changes should be indicated for all children at risk of developing injuries due to pre-, peri-, and postnatal causes 15 . Intracranial hemorrhage has great relevance, because of its immediate and future severity, considering the consequent neurological disorders, all of which have multiple causes, including vascular, hemodynamic, inflammatory, and infectious factors. ...
... Moreover, these disorders can cause significant neuropsychomotor sequelae and lead to cerebral palsyand or cognitive and behavioral deficits 16 . Transfontanellar ultrasound has become the first-choice modality to study the brain of premature infants and to diagnose PIVH, since it is a cheap, bedside method that does not require patient transport, thus reducing risk of complications 15 . ...
Objective
To assess early-onset sepsis as a risk factor of peri-intraventricular hemorrhage in premature infants born at less than or equal to 34 weeks’ gestation and admitted to a neonatal intensive care unit (NICU).
Methods
This retrospective cohort study included premature patients born at less than or equal to 34 weeks’ gestation who were admitted to the NICU of a tertiary hospital in southern Brazil, and born from January 2017 to July 2021. Data were collected from patients’ medical records. Early-onset sepsis was measured according to the presence or absence of diagnosis within the first 72 hours of life, whereas the outcome, peri-intraventricular hemorrhage, was described as the presence or absence of hemorrhage, regardless of its grade.
Results
Hazard ratios were calculated using Cox regression models. A total of 487 patients were included in the study, of which 169 (34.7%) had some degree of peri-intraventricular hemorrhage. Early-onset sepsis was present in 41.6% of the cases of peri-intraventricular hemorrhage, which revealed a significant association between these variables, with increased risk of the outcome in the presence of sepsis. In the final multivariate model, the hazard ratio for early-onset sepsis was 1.52 (95% confidence interval 1.01–2.27).
Conclusion
Early-onset sepsis and the use of surfactants showed to increase the occurrence of the outcome in premature children born at less than or equal to 34 weeks’ gestation. Meanwhile, factors such as antenatal corticosteroids and gestational age closer to 34 weeks’ gestations were found to reduce the risk of peri-intraventricular hemorrhage.
Keywords:
Premature infant; Neonatal sepsis; Neonatal intensive care units; Cerebral intraventricular hemorrhage
... Based on the current literature [18] and current local NICU clinical practice, six coronal and five sagittal views were predefined as standard, allowing a total of 77 anatomical landmarks to be analysed per US study (Figs. 1 and 2, Table 1). ...
... Although the main purpose of any diagnostic tool is to correctly identify pathology, it is first necessary to ensure that the imaging modality being used can depict all the relevant anatomy. To date, it had not been demonstrated that 3-D US could perform at least equally to 2-D in this respect, with the ability to obtain the views considered necessary to comprise a neonatal cranial study that meets the internationally recognised quality criteria [18]. ...
Background
Cranial ultrasound is frequently performed in neonatal intensive care units and acquiring 2-dimensional (D) images requires significant training. Three-D ultrasound images can be acquired semi-automatically.
Objective
This proof-of-concept study aimed to demonstrate that 3-D study image quality compares well with 2-D. If this is successful, 3-D images could be acquired in remote areas and read remotely by experts.
Materials and methods
This was a prospective study of 20 neonates, who underwent both routine 2-D and 3-D cranial ultrasounds. Images were reconstructed into standard views extracted from the 3-D volume and evaluated by three radiologists blinded to the acquisition method. The radiologists assessed for the presence of anatomical landmarks and overall image quality.
Results
More anatomical structures were identified in the 3-D studies (P<0.01). There was a trend that 3-D ultrasound demonstrated better image quality in the coronal plane, and 2-D in the sagittal plane, only reaching statistical significance for two coronal views and two sagittal views.
Conclusion
Overall, this study has demonstrated that 3-D cranial ultrasound performs similarly to 2-D and could be implemented into neonatal practice.
... Neurosonography remains the first-line neuroimaging modality for the evaluation of the brain during the first year of life. It is radiation-free and can be performed immediately after birth, providing fast and real-time images [3]. The anterior fontanel is the main window of exploration. ...
Pediatric intracranial arteriovenous shunts are rare vascular malformations that can be diagnosed prenatally or postnatally, as an incidental finding or due to complications. We propose a review of cerebral vascular malformations in newborns and infants with special emphasis on neurosonography and Doppler ultrasound as the first diagnostic method. Sonography can thus contribute in the planning of further studies that are always necessary, and in post-therapy follow-up.
Graphical Abstract
... A high-resolution probe ( ≥ 7.5 MHz) is essential to detect all cases of white matter injury. 66 In our experience, it is fundamental to obtain brain ultrasound imaging on the first day of life, in the pre-operative period, and undoubtedly after surgery, given their hemodynamic pre-and post-surgery instability. ...
... 71 Considering these data, the use of mastoid fontanel should be encouraged in neonates with CDH, to better detect both congenital and acquired posterior fossa abnormalities (in particular cerebellar hemorrhages) and measure cerebellar diameters. 66,72,73 Conditions that alter cerebral blood flow (CBF) can affect inutero brain development. 74,75 In left-sided CDH, there is an association between smaller left-sided cardiac structures and reduced left ventricular cardiac output. ...
In the last few years, current evidence has supported the use of point-of-care ultrasound (POCUS) for a number of diagnostic and procedural applications. Considering the valuable information that POCUS can give, we propose a standardized protocol for the management of neonates with a congenital diaphragmatic hernia (CDH-POCUS protocol) in the neonatal intensive care unit. Indeed, POCUS could be a valid tool for the neonatologist through the evaluation of 1) cardiac function and pulmonary hypertension; 2) lung volumes, postoperative pleural effusion or pneumothorax; 3) splanchnic and renal perfusion, malrotations, and/or signs of necrotizing enterocolitis; 4) cerebral perfusion and eventual brain lesions that could contribute to neurodevelopmental impairment. In this article, we discuss the state-of-the-art in neonatal POCUS for which concerns congenital diaphragmatic hernia (CDH), and we provide suggestions to improve its use. IMPACT: This review shows how point-of-care ultrasound (POCUS) could be a valid tool for managing neonates with congenital diaphragmatic hernia (CDH) after birth. Our manuscript underscores the importance of standardized protocols in neonates with CDH. Beyond the well-known role of echocardiography, ultrasound of lungs, splanchnic organs, and brain can be useful. The use of POCUS should be encouraged to improve ventilation strategies, systemic perfusion, and enteral feeding, and to intercept any early signs related to future neurodevelopmental impairment.
... and feeding regimens of pups and rabbits, the difference in IVH induction between experiment A and B can be due to other factors that are less controllable, such as seasonal variability between the litters, skewed genetic background of bucks and/or does, or other coincidences or factors not considered. Cerebral ultrasound is a non-invasive, bedside neuroimaging tool for detection and follow up of IVH in the premature infant and is widely implemented in clinical neonatal care 43 . In our preclinical model of glycerolinduced cerebral hemorrhage, we have adopted a similar approach, examining the rabbit pups for cranial bleeding using HFU with a 40 MHz probe. ...
Insulin-like growth factor-1 (IGF-1) is essential for normal brain development and regulates processes of vascular maturation. The pathogenesis of intraventricular hemorrhage (IVH) relates to the fragility of the immature capillaries in the germinal matrix, and its inability to resist fluctuations in cerebral blood flow. In this work, using different experimental setups, we aimed to (i) establish an optimal time-point for glycerol-induction of IVH in relation to time-point of recombinant human (rh) IGF-1/rhIGFBP-3 administration, and (ii) to evaluate the effects of a physiologic replacement dose of rhIGF-1/rhIGFBP-3 on prevention of IVH and survival in the preterm rabbit pup. The presence of IVH was evaluated using high-frequency ultrasound and post-mortem examinations. In the first part of the study, the highest incidence of IVH (> 60%), occurred when glycerol was administered at the earliest timepoint, e.g., 6 h after birth. At later time-points (18 and 24 h) the incidence decreased substantially. In the second part of the study, the incidence of IVH and mortality rate following rhIGF-1/rhIGFBP-3 administration was not statistically different compared to vehicle treated animals. To evaluate the importance of maintaining intrauterine serum levels of IGF-1 following preterm birth, as reported in human interventional studies, additional studies are needed to further characterize and establish the potential of rhIGF-1/rhIGFBP-3 in reducing the prevalence of IVH and improving survival in the preterm rabbit pup.
... Postnatal screening with USG is indicated for newborns at risk or with suspected brain injury. Risk factors and clinical signs of neonatal brain injury are present in table 1, according to Jeroen Dudink et al. 6 ...
... 8,9,10 Table 1 -Risk factors and clinical signs of neonatal brain injury. 6 As the Image gently 11 highlights, it is important to note that radiation reduction may be hard to achieve since it can increase the quantum mottle or background noise of CT images. Neuroradiologists should work closely with medical physicists to achieve the best equilibrium of lowest radiation dose and image quality for accurate diagnosis. ...
Paediatric neuroimaging is distinct from adult imaging, warranting dedicated approaches that take into account the singularities of this population in the selection of the appropriate imaging techniques for each phase of the normal development. The impact of ionising radiation exposure or contrast media usage need to be taken into account when planning or performing paediatric imaging, with risk versus benefit needing a specific assessment in these age groups, especially considering x-ray exposure. Magnetic resonance is radiation free and provides accurate anatomical detail of the brain and spinal cord, being the preferred imaging method in children, despite some reported adverse effects. To produce high quality images, neuroradiologists must be aware that there are several challenges in children mainly due to their small size and immaturity. Non-cooperation is a challenge in this group that demands creativity (with specific devices to use inside the scanners) and fast imaging methods, minimising the use of anaesthetics.The scope of this article is to review the challenges of paediatric neuroimaging, focusing on the specificities of these patients, namely main indications for imaging, risks and concerns regarding the most commonly used neuroimaging techniques available, use of contrast media and the need of sedation or general anaesthesia, and to provide recommendations that optimise safety in paediatric neuroimaging, proposing an algorithm approach based on risk/benefit assessment.
... It was also difficult to obtain a complete view of the brain's periphery, such as along the posterior fossa. White matter injuries and interobserver variability were nearly impossible to diffuse accurately due to poor visibility (Audrey and Procter, 2015;Dudink et al., 2020). Cerebellar hemorrhages were also discovered to be difficult to detect due to the distinction between frequency, extent, and sequelae. ...
This scholarly investigation undertakes a comprehensive comparison of the diagnostic efficacy, precision, and sensitivity associated with neonatal brain Magnetic Resonance Imaging (MRI) in contrast to its counterparts, Computed Tomography (CT) scans and ultrasound. As the medical community has progressively become attuned to the long-term health implications of radiation exposure from CT scans, the imperative of a strategy mitigating this risk has gained prominence. In this context, ultrasound emerges as an alternative modality devoid of ionizing radiation. Employing a methodical approach rooted in systematic literature review, this study synthesizes five pertinent research works to unravel its research objectives. Empirical evidence substantiates that neonatal brain MRI surpasses both neonatal brain CT and ultrasound in diagnostic effectiveness. The underpinning rationale for this phenomenon lies in the heightened accuracy inherent to neonatal brain MRI procedures. To unravel the intricacies associated with disparities between neonatal and adult brain MRI procedures, the study meticulously investigates structural, shape, and size distinctions. This endeavor underscores the necessity for bespoke MRI apparatuses designed to account for these nuances. In pursuit of this objective, the integration of technologically advanced components such as compact scanners and refinements in magnetic and coil technologies has engendered tangible improvements. This innovation confluence bears testimony to the augmentation of patient safety, conferring a cascade effect wherein the precision of acquired MRI data underwrites accurate diagnoses and consequent therapeutic interventions. Conclusively, the study underscores the pivotal role played by recent MRI technological advancements in amplifying its efficacy within the niche domain of neonatal brain imaging. Prospective innovations within the MRI ambit stand poised to recalibrate performance benchmarks, thereby amplifying its diagnostic potency and broadening its scope of application.
... The transducer should be sized according to the fontanelle, the pressure on the baby's head should be minimal and the gel should be warmed. The examination is usually performed with a frequency of 7.5-11 MHz (Dudink et al., 2020). ...
The ultrasound in medicine today is already tested and proven method,with relatively longtradition and training period.It has been versed and still tested in various branches of medicine, and among the first experiences, it was in neonatesaround the 1970s.Today, monitoring and supervision critically ill neonates, particularly premature infants, placed in incubator, is almost impossible without ultrasound. By this method, we are ableexamine and evaluate critically ill neonates at the patient's bedside, with minimum manipulating, without sedation, without anesthesia or contrast agents. Transfontaneal neonatal brain ultrasoundprovides diagnosis and assessment trend of brain changes through repeated examinations, without harmful radiation to child, which is important because in some conditions, serial examination is necessary to detect the full spectrum of lesional change. This review aims to highlight the importance of transfontanel brain ultrasound in neonates, and to provide a tool for structured neonatal brain ultrasound scanning, reporting and quality assessment.Keywords:ultrasound, brain, neonate, assessment.
