310 - The Utility of Screening Head Ultrasounds at Term Equivalent Age in Preterm Neonates

Publication Number: 310.6875

Sarah Batt, Creighton University School of Medicine, Phoenix, AZ, United States; Victoria Johnson, Creighton University School of Medicine, Omaha, NE, United States; Hadi Berbari, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Hemananda Muniraman, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States

Background: In their 2020 clinical report, the American Academy of Pediatrics (AAP) published a clinical report recommending routine head ultrasounds (HUS) to screen for intraventricular hemorrhage (IVH) in preterm neonates born at or before 30 weeks’ gestational age. These guidelines recommended obtaining routine HUS at 7-10 days, 4-6 weeks of age, and at term equivalent age or near discharge.

Objective: The objective of this study was to evaluate the incidence of detecting abnormalities on HUS at each of the recommended time points and to reassess the utility of these guidelines, particularly of the HUS at term equivalent age when the prior HUS were negative, with the goal of streamlining the recommendations to minimize HUS and maximize detection of abnormalities.

Design/Methods: This was a retrospective cohort study in a level III neonatal intensive care unit between January 2016 and December 2023. The study included preterm infants born prior to 32 weeks with birth weight of 1500 grams or less. Timing and abnormalities on each of the recommended HUS were described.

Results: A total of 733 patients were included. 595 infants underwent HUS at 7-10 days of life, of which 364 (61.2%) were normal (Table 1). Of these 364 infants, 48 (13.2%) had new abnormalities detected on the HUS at 4-6 weeks of life, 20 (41.7%) of which were benign cysts. 7 (1.9%) infants had grade 1 IVH, and 4 (1.1%) had grade 2 IVH. In this subset, no patients with normal HUS at 7-10 days of life were found to have grade 3 or grade 4 IVH or intracerebral hemorrhage (ICH) on HUS at 4-6 weeks of life. Out of these 364 infants, 290 also had a normal HUS at 4-6 weeks of life. In this subset, there were 9 (3.1%) new abnormalities detected on HUS at term equivalent age with the most common being benign cysts again (33.3%). 1 (0.3%) infant had grade 1 IVH on HUS at term equivalent age. None of these patients had grade 2, 3, or 4 IVH or ICH (Table 2).

Conclusion(s): Of the infants with a normal HUS at 7-10 days and at 4-6 weeks of life, 3.1% of infants had a new abnormality on their HUS at term equivalent age, with most of these representing benign pathologies. In terms of IVH, there was only 1 new grade 1 IVH detected. None of these patients had grade 2, 3, or 4 IVH or ICH. In an otherwise uncomplicated neonatal course and an unremarkable HUS at 7-10 days of life and at 4-6 weeks of age, we conclude that these two HUS may be sufficient to detect all consequential abnormalities and that the third HUS at term equivalent age may be foregone for better resource utilization. However, larger, multi-center studies are required to make conclusive recommendations.

Table 1: Abnormalities Detected by HUS at <7 days, 7-10 days, 4-6 weeks, and TEA


Table 2: New Abnormalities Detected after Normal HUS on Next AAP Recommended HUS