Neonatal Med.  2022 May;29(2):57-67. 10.5385/nm.2022.29.2.57.

Neonatologist-Performed Cranial Ultrasonography in the Neonatal Intensive Care Unit

• Cho HJ
• Kim EJ
• Son DW

• KMID: 2530608
• DOI: http://doi.org/10.5385/nm.2022.29.2.57

Abstract

Cranial ultrasound (CUS) is an initial screening imaging tool used to evaluate the neonatal brain. It is an accessible, inexpensive, and harmless technique that can be used at bedside as frequently as required. Timely focused CUS in the neonatal care unit can play a major role in the diagnosis, follow-up, and management of brain damage. Despite the increasing use of point-of-care ultrasonography by intensive care physicians, neonatologist-performed CUS remains unusual. This review aims to provide an overview of neonatal CUS to neonatologists, focusing on the optimal settings, standard planes of the brain, and main pathologies in preterm infants. Adding Doppler studies allows evaluation of the patency of intracranial arteries and veins, flow velocities, and indices. This may provide an opportunity for earlier targeted circulatory support to prevent brain injury and improve long-term neurodevelopmental outcomes.

Keyword

Ultrasonography; Ultrasonography, Doppler; Cerebral intraventricular hemorrhage; Point-of-care testing; Infant, newborn

Figure

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  Figure 1. Three different types of probes. (A) Convex (curved) probe. (B) Linear probe. (C) Sector (phased array) probe.

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  Figure 2. Standard coronal images of the brain through the anterior fontanelle. (A) First standard coronal image through the frontal lobes. (B) Second coronal image through the frontal horns of the lateral ventricles. (C) Third coronal image through the third ventricle. (D) Fourth coronal image at the level of the cerebellum. (E) Fifth coronal image through the trigone of the lateral ventricle. (F) Sixth coronal image through the occipital lobes.

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  Figure 3. Standard sagittal images of the brain through the anterior fontanelle. (A) Midline sagittal image. (B) Parasagittal image. (C) Lateral parasagittal image.

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  Figure 4. Color and pulsed Doppler evaluation in the midline sagittal plane. (A) Resistive index (RI), peak systolic velocity (PSV) and end diastolic velocity (EDV) in the anterior cerebral artery (ACA) are automatically evaluated using spectral Doppler tracings. (B) Perfusion waveform of the internal cerebral vein (ICV) shows a steady waveform with a constant perfusion speed (Grade 0 fluctuation). (C) Perfusion waveform of the ICV fluctuates; however, the minimum speed is never less than half the maximum speed (Grade 1 fluctuation).

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  Figure 5. Ultrasound findings of germinal matrix-intraventricular hemorrhage (GMH-IVH). (A,B) Grade I GMH-IVH. The location of the echogenic clot (arrows) at the right caudothalamic notch is typical of grade I GMH-IVH. (C,D) Grade II GMH-IVH. Coronal scan shows echogenic clot involving the caudate nucleus (arrows). Parasagittal scan shows the same clot centered at the caudothalamic notch (arrows) and the intraventricular hemorrhage within the occipital horn separate to choroid plexus (arrowhead). (E,F) Grade III GMH-IVH. Coronal scan shows a large left GMH-IVH (arrows) with intraventricular blood acutely distending its lateral ventricle. Note also the enlarged temporal ventricular horns. A small amount of blood in the right lateral ventricle (arrowhead) is present. Parasagittal view shows that the left grade III GMH-IVH fills >50% of the distended lateral ventricle. (G,H) Grade IV GMH-IVH. Coronal scan showing a left-sided grade III GMH-IVH (arrowhead) and large echodensity in the left frontoparietal white matter (arrow). Smaller right-sided grade II GMH-IVH (arrowhead). Left parasagittal scan showing the periventricular echodensity (arrows) extending from the posterior frontal white matter to the parietal white matter.

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  Figure 6. Measurements of the ventricle size in post-hemorrhagic ventricular dilatation. (A) Measurements of the ventricular index (VI), anterior horn width (AHW), and ventricle/brain ratio on coronal scan. (B) Measurements of the thalamo-occipital distance (TOD) on sagittal scan.

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  Figure 7. Ultrasound findings in a preterm infant (24 weeks of gestational age) with periventricular leukomalacia. (A) Coronal scan shows scattered hyperechoic lesions in the periventricular white matter. (B) Coronal scan 4 weeks later shows multiple cysts extending from the frontal lobe to the trigone area.

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  Figure 8. Ultrasound findings in a preterm infant (25 weeks of gestational age) with bilateral intraventricular hemorrhage and left periventricular hemorrhagic infarction (PVHI). (A) Coronal scan shows a large echodensity in the left frontoparietal white matter. (B) Coronal scan 2 weeks later shows cystic degeneration following the PVHI with echogenic clot debris.

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