Original Articles
Ultrasound abnormalities preceding cerebral palsy in high-risk preterm infants

https://doi.org/10.1016/j.jpeds.2004.03.034Get rights and content

Abstract

Objective

To assess sequential high-resolution cranial ultrasound (US) in high-risk preterm infants to predict cerebral palsy (CP).

Study design

Preterm infants were prospectively studied (n = 2139), 1636 ≤32 weeks gestational age (GA) (group A) and 503 with a GA of 33 to 36 weeks (group B). US was performed once a week until discharge and at 40 weeks postmenstrual age (PMA), using a 7.5-MHz transducer. Grade III and IV hemorrhage, cystic periventricular leukomalacia (c-PVL), and focal infarction were considered major US abnormalities. A diagnosis of CP was made at a minimum age of 24 months.

Results

Seventy-six (5%) of the 1460 survivors in group A developed CP. US abnormalities were present in 70 of 76 (92%) infants, being major in 58 (83%) and minor in 12 (17%). In 29% of the CP cases with major US abnormalities, cysts were first detected beyond day 28. A further 6 infants without US abnormalities developed CP, and 3 of these infants developed ataxic CP.

Twenty-nine (6%) of the 469 survivors in group B developed CP. US abnormalities were present in 28 of 29 (96%) infants, being major in 25 (89%) and minor in 3 (11%). One infant without US abnormalities developed CP.

Considering the major US abnormalities, a specificity of 95% and 99% and a sensitivity of 76% and 86% were found for group A and B, respectively. The positive predictive value was 48% in group A and 83% in group B.

Conclusion

Seventy-nine percent of our CP cases had major US abnormalities. To detect c-PVL, the most predictive US marker for CP, sequential scans with a 7.5-MHz transducer are required.

Section snippets

Patients and methods

All preterm infants with a gestational age (GA) ≤36 weeks, admitted to the neonatal intensive care unit of the Wilhelmina Children's Hospital (a tertiary referral center) and born between January 1990 and January 1999, were studied prospectively using cranial US. Infants with chromosomal disorders, congenital abnormalities, congenital infections, and proven metabolic disorders were excluded. Those who survived were seen in the follow-up clinic at regular intervals. The pediatric physiotherapist

Results

Of the 2139 children who met the entry criteria, 1636 were ≤32 weeks GA; 176 (11%) died, and 1460 infants survived. Five hundred and three infants with a GA of 33 to 36 weeks were admitted; 34 (7%) died, and 469 survived the neonatal period. More than 80% of all infants and all but 2 of those with major US abnormalities were seen in the follow-up clinic. If any of the children without major US abnormalities go on to develop CP, they are referred to our hospital, either to our neonatal follow-up

Discussion

Using sequential high-resolution cranial US until discharge and at 40 weeks PMA, major US abnormalities were detected in 79% of the children who developed CP during infancy. Only 7 of 105 children with CP had completely normal US findings. CP was mild in the infants with a normal US scan, and all achieved independent walking. US was unable to detect abnormalities in 3 infants who subsequently developed cerebellar ataxia. Two of these 3 infants with ataxia were severely growth retarded, and

References (35)

  • T.E Inder et al.

    White matter injury in the premature infant: a comparison between serial cranial sonographic and MR findings at term

    Am J Neuroradiol

    (2003)
  • T Debillon et al.

    Limitations of ultrasonography for diagnosing white matter damage in preterm infants

    Arch Dis Child Fetal Neonatal Edition

    (2003)
  • S.P Miller et al.

    Comparing the diagnosis of white matter injury in premature newborns with serial MR imaging and transfontanel ultrasonography findings

    Am J Neuroradiol

    (2003)
  • T.M O'Shea et al.

    Prenatal events and the risk of cerebral palsy in very low birth weight infants

    Am J Epidemiol

    (1998)
  • M Wheater et al.

    Perinatal infection is an important risk factor for cerebral palsy in very low birthweight infants

    Dev Med Child Neurol

    (2000)
  • K.B Nelson et al.

    Neonatal cytokines and cerebral palsy in very preterm infants

    Pediatr Res

    (2003)
  • V.N Nwafor-Anene et al.

    Serial head ultrasound studies in preterm infants: how many normal studies does one infant need to exclude significant abnormalities?

    J Perinatol

    (2003)
  • Cited by (320)

    • Brain Injury in the Preterm Infant

      2023, Avery's Diseases of the Newborn
    • Risk Assessment and Neurodevelopmental Outcomes

      2023, Avery's Diseases of the Newborn
    View all citing articles on Scopus
    View full text