The relations between lesions detected by ultrasound brain-imaging and neurodevelopmental outcome at 8 years in a cohort of 206 very preterm infants were studied at the Department of Paediatrics, University College and Middlesex School of Medicine, London. Scans were normal at discharge from hospital in 112 (54%), and of these, 4% developed major, disabling impairment and 22% had minor impairments. Uncomplicated periventricular hemorrhage (PVH) was diagnosed in 55 (27%), ventricular dilatation in 21 (10%), hydrocephalus developed in 5, and cerebral atrophy was found in 13 (6%). Disabling neurodevelopmental impairments, including epilepsy, mental retardation and cerebral palsy, were documented in 25 children at follow-up (12%). Ventricular dilatation and cerebral atrophy were significant independent predictors of impairment of neurodevelopment, of school performance or achievement, and of the WISC-R Full-scale and Performance subscale IQs. [1]
COMMENT. A normal ultrasound scan or a finding of uncomplicated periventricular hemorrhage in very preterm infants permits reassurance and the likelihood of a favorable developmental outcome. In contrast, infants with ventricular dilatation, hydrocephalus and cerebral atrophy have a poor prognosis. Learning difficulties experienced by some preterm infants may be caused by undetected hypoxic-ischemic injury.
Routine ultrasound screening in a multicenter study involving 15,151 pregnant women did not improve perinatal outcome when compared to the selective use of ultrasonography only for medical indications on the basis of clinical judgment. [2]