Day 1 Cranial Ultrasonography Detects Prenatal Brain Abnormalities in Preterm Infants: A Retrospective Cohort Study
Rim Kasem Ali Sliman, Michal Molad, Dan Waisman, Karen Lavie Nevo, Marina SoloveichickBackground
Current guidelines recommend cranial ultrasonography (CUS) screening at 7-14 days for infants <30 weeks of gestation. However, emerging evidence suggests that significant prenatal brain injuries may be missed by delayed screening protocols.
Objective
To evaluate the diagnostic yield of day 1 CUS in identifying prenatal brain abnormalities across all preterm gestational ages.
Methods
Retrospective cohort study of 365 preterm infants (24.0-36.6 weeks of gestation) who underwent CUS within 24 hours of birth at a tertiary neonatal intensive care unit (June 2014–July 2020). CUS findings were analyzed by gestational age groups, with particular attention to signs of prenatal hemorrhage and white matter abnormalities. Images were independently reviewed by 2 board-certified neonatologists with consensus review for discordant cases.
Results
Day 1 CUS revealed pathologic findings in 141 of 365 infants (38.6%), with gestational age–dependent prevalence: 44 of 69 (63.8%) extremely preterm (24-30 weeks), 53 of 129 (41.1%) very preterm (30.1-33.6 weeks), and 44 of 167 (26.3%) moderate to late preterm (34-36.6 weeks). Intraventricular hemorrhage (IVH) occurred in 58 of 365 infants (15.9%), with 31 of 58 cases (53.4%) showing clot liquefaction suggestive of prenatal onset. Critically, 14 of 58 IVH cases (24.1%) completely resolved on follow-up imaging. White matter lesions were identified in 49 of 365 infants (13.4%), demonstrating marked gestational age dependence: 25 of 69 (36.2%) extremely preterm, 23 of 129 (17.8%) very preterm, and 1 of 167 (0.6%) moderate-late preterm infants.
Conclusions
Day 1 CUS identifies findings suggestive of prenatal brain pathology across all preterm gestational ages. Nearly one-quarter of early IVH cases resolve before conventional screening times. These findings suggest that earlier CUS may warrant further evaluation as a potential adjunct to current protocols; however, prospective studies with neurodevelopmental follow-up are needed before any change to screening practice can be recommended.