Citation Information :
McLean G, Razak A, Ditchfield M, Lombardo P, Malhotra A. Evaluation of a Cranial Ultrasound Scoring System for Prediction of Abnormal Early Neurodevelopment in Preterm Infants. 2023; 2 (2):122-127.
Aim: To evaluate and compare a cranial ultrasound (cUS) scoring system to conventional reporting of cranial ultrasound abnormalities (CUAs) for prediction of early neurodevelopmental outcomes in preterm infants.
Materials and methods: This retrospective, single-center study compared cUS scores to results from late ultrasound examination reports for any cUS abnormality (CUA) (any hemorrhage or white matter lesion) or severe CUA [severe intraventricular hemorrhage (IVH)], cystic periventricular leukomalacia (PVL), parenchymal or cerebellar hemorrhage) for predicting early signs of cerebral palsy (CP) or developmental delay in preterm infants.
Results: Six-weeks postnatal cUS examinations were analyzed against early neurodevelopmental outcomes at 3–4-months corrected age of 242 preterm infants (median gestational age, 26.5 weeks; interquartile range [IQR, 4 weeks] and median body weight 880 grams [IQR, 356.5 grams]). We did not find any statistically significant differences between cUS score and any CUA for sensitivity (57% vs 57% [95% confidence interval (CI): from −19 to 19]) and specificity (68% vs 64% [95% CI: from −3 to 10]) for predicting CP. Similarly, there was no difference in sensitivity (44% vs 46% [95% CI: from −12 to 7]) and specificity (74% vs 70% [95% CI: from −5 to 13]) for predicting any developmental delay. However, in comparison to severe CUA, cUS score had significantly higher sensitivity (57% vs 27% [95% CI: from 12 to 49]) but significantly lower specificity (68% vs 96% [95% CI: from −21 to −34]) for predicting CP. There was higher sensitivity (44% vs 12 % [95% CI: from 23 to 41]) but lower specificity (74% vs 98% [95% CI: from −15 to −32]) for any delay.
Conclusions: Cranial ultrasound score was similar to any reported CUA for predicting neurodevelopmental outcomes; however, when compared to severe CUA, it had better sensitivity but poor specificity for predicting early neurodevelopmental outcomes.
Clinical significance: Objective scoring of cUS examinations on late neonatal scans was found to be similar to conventional reporting of any CUA for the prediction of early neurodevelopmental outcomes in this retrospective study. This indicates that scoring does not value add to the diagnosis of these infants.
Hwang M, Tierradentro–Garcia LO, Hussaini SH, et al. Ultrasound imaging of preterm brain injury: Fundamentals and updates. Pediatr Radiol 2022;52(4):817–836. DOI: 10.1007/s00247-021-05191-9.
Mohammad K, Scott JN, Leijser LM, et al. Consensus approach for standardizing the screening and classification of preterm brain injury diagnosed with cranial ultrasound: A Canadian perspective. Front Pediatr 2021;9:618236. DOI: 10.3389/fped.2021.618236.
van Wezel–Meijler G, Steggerda SJ, Leijser LM. Cranial ultrasonography in neonates: Role and limitations. Semin Perinatol 2010;34(1):28–38. DOI: 10.1053/j.semperi.2009.10.002.
Novak I, Morgan C, Adde L, et al. Early, accurate diagnosis and early intervention in cerebral palsy. JAMA Pediatrics 2017;171(9):897–907. DOI: 10.1001/jamapediatrics.2017.1689.
Hadders–Algra M, Boxum AG, Hielkema T, et al. Effect of early intervention in infants at very high risk of cerebral palsy: A systematic review. Dev Med Child Neurol 2017;59(3):246–258. DOI: 10.1111/dmcn.13331.
Byrne R, Noritz G, Maitre NL, Group NCHED. Implementation of early diagnosis and intervention guidelines for cerebral palsy in a high-risk infant follow-up clinic. Pediatr Neurol 2017;76:66–71. DOI: 10.1016/j.pediatrneurol.2017.08.002.
Brouwer AJ, Groenendaal F, Benders MJNL, et al. Early and late complications of germinal matrix-intraventricular haemorrhage in the preterm infant: What is new? Neonatology 2014;106(4):296–303. DOI: 10.1159/000365127.
Inder TE, de Vries LS, Ferriero DM, et al. Neuroimaging of the preterm brain: Review and recommendations. J Pediatr 2021:276e4–287e4. DOI: 10.1016/j.jpeds.2021.06.014.
McLean G, Malhotra A, Lombardo P, et al. Cranial ultrasound screening protocols for very preterm infants. Ultrasound Med Biol 2021;47(7):1645–1656. DOI: 10.1016/j.ultrasmedbio.2021.03.006.
Skiöld B, Hallberg B, Vollmer B, et al. A novel scoring system for term–equivalent-age cranial ultrasound in extremely preterm infants. Ultrasound Med Biol 2019;45(3):786–794. DOI: 10.1016/j.ultrasmedbio.2018.11.005.
Horsch S, Skiöld B, Hallberg B, et al. Cranial ultrasound and MRI at term age in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed 2010;95(5):F310-4. DOI: 10.1136/adc.2009.161547.
King AR, Machipisa C, Finlayson F, et al. Early detection of cerebral palsy in high-risk infants: Translation of evidence into practice in an Australian hospital. J Paediatr Child Health 2021;57(2):246–250. DOI: 10.1111/jpc.15191.
Connors R, Sackett V, Machipisa C, et al. Assessing the utility of neonatal screening assessments in early diagnosis of cerebral palsy in preterm infants. Brain Sci 2022;12(7):847. DOI: 10.3390/brainsci12070847.
Papile LA, Burstein J, Burstein R, et al. 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):529–534. DOI: 10.1016/s0022-3476(78)80282-0.
Volpe JJ. Intraventricular hemorrhage in the premature infant: Current concepts. Part I. Ann Neurol 1989;25(1):3–11. DOI: 10.1002/ana.410250103.
de Vries LS, Benders MJ, Groenendaal F. Progress in neonatal neurology with a focus on neuroimaging in the preterm infant. Neuropediatrics 2015;46(4):234–241. DOI: 10.1055/s-0035-1554102.
Hand IL, Shellhaas RA, Milla SS, et al. Routine neuroimaging of the preterm brain. Pediatrics 2020;146(5):e2020029082. DOI: 10.1542/peds.2020-029082.
Einspieler C, Prechtl HF. Prechtl's assessment of general movements: A diagnostic tool for the functional assessment of the young nervous system. Ment Retard Dev Disabil Res Rev 2005;11(1):61–67. DOI: 10.1002/mrdd.20051.
Romeo DM, Cioni M, Scoto M, et al. Neuromotor development in infants with cerebral palsy investigated by the Hammersmith Infant Neurological Examination during the first year of age. Eur J Paediatr Neurol 2008;12(1):24–31. DOI: 10.1016/j.ejpn.2007.05.006.
Hintz SR, Barnes PD, Bulas D, et al. Neuroimaging and neurodevelopmental outcome in extremely preterm infants. Pediatrics 2015;135(1):e32–e42. DOI: 10.1542/peds.2014-0898.
Edwards AD, Redshaw ME, Kennea N, et al. Effect of MRI on preterm infants and their families: A randomised trial with nested diagnostic and economic evaluation. Arch Dis Child Fetal Neonatal Ed 2018;103(1):F15–F21. DOI: 10.1136/archdischild-2017-313102.
Kidokoro H, Neil JJ, Inder TE. New MR imaging assessment tool to define brain abnormalities in very preterm infants at term. Am J Neuroradiol 2013;34(11):2208–2214. DOI: 10.3174/ajnr.A3521.
Woodward LJ, Anderson PJ, Austin NC, et al. Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. N Engl J Med 2006;355(7):685–694. DOI: 10.1056/NEJMoa053792.
Goeral K, Kasprian G, Huning BM, et al. A novel magnetic resonance imaging-based scoring system to predict outcome in neonates born preterm with intraventricular haemorrhage. Dev Med Child Neurol 2022;64(5):608–617. DOI: 10.1111/dmcn.15116.