Knowledge of Safety, Training, and Practice of Neonatal Cranial Ultrasound: A Survey of Operators

Lalzad, Assema; Wong, Flora Y.; Singh, N.; Coombs, Peter; Brockley, Cain; Brennan, Sonja; Ditchfield, Michael; Rao, Padma; Watkins, Andrew; Saxton, Virginia; Schneider, Michal

doi:10.1002/jum.14481

Cited by 14 publications

(23 citation statements)

References 41 publications

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“…Nevertheless, more and more studies are currently discussing potential risks and limited knowledge among health care professionals when it comes to applying high-energy levels in the neonatal brain, for example, through the use of Doppler sonography. 31 The same would seem to be true of SWE; thus practitioners should consider the applied energy, recommended maximum examination times, and potential risks such as tissue warming when using B-mode, Power Doppler, and SWE. But sonographic brain imaging seems to be reasonably low-risk compared with alternative imaging methods like MRI or CT, in which the administered energy levels are far higher and associated with potentially more dangerous biological risks especially where ionizing x-rays are involved.…”

Section: Discussionmentioning

confidence: 99%

Transcranial Shear Wave Elastography of Neonatal and Infant Brains for Quantitative Evaluation of Increased Intracranial Pressure

et al. 2019

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Objectives: Increased intracranial pressure (ICP) in neonates and infants is a severe disease state that requires adequate diagnosis and, depending on the clinical situation and whether it is increasing, a rapid and efficient therapy. Clinical evaluation, B-mode ultrasound, and Doppler ultrasound give rise to a basic noninvasive diagnosis of increased ICP. The purpose of this prospective study was 2-fold: first, to analyze the technical feasibility of obtaining shear wave elastography (SWE) measurements of an infant's brain, and second, to compare the values of healthy neonates to those who have hydrocephalus and are either suspected of having or invasively shown to have increased ICP. Materials and Methods: This was a prospective, institutional review boardapproved study of 184 neonates and infants with a mean age of 12 weeks (ranging from 1 day to 12 months). The final, technical evaluable cohort consisted of 166 infants, of whom 110 were healthy asymptomatic infants and 56 were diagnosed with hydrocephalus. Of the latter, 38 showed clinically increased ICP and 18 did not. Invasive ICP measurements were available from 47 of the children. All infants underwent systematic examination using B-mode ultrasound, Doppler ultrasound, and SWE using a high-resolution linear 15-MHz probe (Aixplorer; Supersonic), by 1 of 2 radiologists, each of whom had at least 5 years' experience examining children's brains and applying SWE. Semiquantitative and quantitative SWE measurements were performed.We compared the SWE values to each participant's clinical symptoms and to their invasive ICP measurement results. Correlations were calculated using Pearson and Spearman correlation coefficients. We used Student t test to compare the mean SWE values in healthy children to those of children with increased ICP. Results: Shear wave elastography in the brain was technically feasible, giving reliable SWE measurements in 110 (88.7%) of 124 of healthy children and in 56 (93.3%) of 60 children with hydrocephalus. Shear wave elastography values and, thus, rigidity in the brain's parenchyma were significantly higher in children with hydrocephalus (n = 56) than in healthy children (n = 110; mean, 21.8 kPa vs 14.1 kPa; P = 0.0083). A thorough correlation between invasive ICP measurements and SWE values in a subgroup of patients with hydrocephalus revealed a direct correlation between increased ICP and increased SWE values (r = 0.69, P < 0.001). Mean SWE values were 30.8 kPa (range, 23.9-62.3 kPa) in patients with confirmed increased ICP (n = 35) versus 16.2 kPa (range, 10.2-41.9 kPa) in patients with nonincreased ICP (n = 12). Conclusions: Shear wave elastography is feasible in neonates with increased ICP and could be a useful additional diagnostic imaging and monitoring method for children verified or suspected to have increased ICP. However, more evidence is necessary to further evaluate the usefulness of SWE measurements in neonates with hydrocephalus. Clinical Relevance: Shear wave elastography can be used as a surrogate marker for ICP in neon...

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Section: Discussionmentioning

confidence: 99%

Transcranial Shear Wave Elastography of Neonatal and Infant Brains for Quantitative Evaluation of Increased Intracranial Pressure

et al. 2019

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“…When transcranial ultrasound is widely used, however, people tend to overlook the potential biological impacts. 18 The interaction between ultrasound and biological tissues has been fully confirmed, 19 mainly including thermal and mechanical effects. To evaluate the potential risks of ultrasound examinations, the US Food and Drug Administration implemented the output display standards, which mainly include measures of the thermal index and mechanical index.…”

Section: Discussionmentioning

confidence: 92%

“…In recent years, some researchers have begun to apply 2D SWE to identify neonatal encephalopathy with good results. When transcranial ultrasound is widely used, however, people tend to overlook the potential biological impacts 18 . The interaction between ultrasound and biological tissues has been fully confirmed, 19 mainly including thermal and mechanical effects.…”

Section: Discussionmentioning

confidence: 99%

A Safety Study of the Effects of 2‐Dimensional Shear Wave Elastography on Synaptic Morphologic Characteristics and Function in the Hippocampus of Neonatal Mice

Zhang

et al. 2020

J of Ultrasound Medicine

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Objectives-The aim of this study was to determine the effects of 2-dimensional (2D) shear wave elastography (SWE) on synaptic morphologic characteristics and function in the neonatal mouse hippocampus and whether it affects the capacity for learning and memory later in life. Methods-We divided neonatal mice into a control group and a 2D SWE group scanned for 10, 20, or 30 minutes. Hippocampal morphologic characteristics were assessed by hematoxylin-eosin and Nissl staining. Ultrastructures of hippocampal neurons were visualized by electron microscopy. Protein and messenger RNA expression levels of synaptophysin, N-methyl-D-aspartate receptor 1 (NMDAR1), NMDAR2A, and NMDAR2B were quantified by a western blot and polymerase chain reaction, respectively. Learning and memory of adult mice were evaluated by the Morris water maze and the novel object recognition task. Results-Compared with the control group, the hippocampal morphologic characteristics of the experimental groups did not differ under light microscopy, and the synaptic structures assessed by electron microscopy appeared normal. Western blot and polymerase chain reaction results showed that expression of synaptophysin, NMDAR1, NMDAR2A, and NMDAR2B were downregulated after exposure to 2D SWE, but there were no statistical differences between the experimental groups. This downregulation disappeared within 24 hours. The results of the Morris water maze and novel object recognition suggested that the 2D SWE scanning on neonatal mice had no effect on learning and memory in adulthood. Conclusions-This study demonstrated that when the mice were exposed to neonatal cranial ultrasound by 2D SWE lasting for longer than 10 minutes, the expression of genes involved in synaptic function was affected, but this effect lasted no longer than 24 hours and did not affect learning and memory in adulthood.

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“…However, all investigators were properly trained and used to routinely perform cUS in our NICU in less than 15 minutes. The duration of exposure is known to be crucial for the risk of a thermal effect, 37,38 but B-GREAT measurements were all taken during a standard scan, recommended in the first days of life, and did not require extra examination time. Another possible bias in our growth charts is that from 32 weeks all measurements are not "first measurements"; thus, they do not represent intrauterine growth.…”

Section: Discussionmentioning

confidence: 99%

Brain Growth Evaluation Assessed with Transfontanellar (B-GREAT) Ultrasound. Old and New Bedside Markers to Estimate Cerebral Growth in Preterm Infants: a Pilot Study

et al. 2021

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Objective: We aimed to investigate the feasibility of evaluating overall preterm brain growth using a gathered set of measurements of brain structures in standard cranial ultrasound planes. We called this method of assessment Brain GRowth Evaluation Assessed with Transfontanellar ultrasound (B-GREAT). Study design: In this prospective observational cohort study, cranial ultrasound was regularly performed (on day 1, 2, 3, 7 of life and then weekly until discharge and at term) in preterm infants born with a gestational age less than 32 weeks. We evaluated Corpus Callosum (CC) length, Corpus Callosum-Fastigium (CCF) length, Anterior Horn Width (AHW), Frontal White Matter (FWM) height, Total brain Surface (TBS), Deep Grey Matter (DGM) height, Hemisphere Height (HH), Transverse Cerebellar Diameter in the axial view (TCDax) and coronal view (TCDcor). Measurements obtained were used to develop growth charts for B-GREAT markers as a function of postmenstrual age. Reproducibility of B-GREAT markers was studied. Results: A total of 528 cranial ultrasounds was performed in 80 neonates (median birth gestational age: 28+5 weeks, interquartile range: 27+3 to 30+5). The intraclass correlation coefficients for intra-observer and inter-observer analyses showed substantial agreement for all B-GREAT markers. Growth curves for B-GREAT markers were developed. Conclusion: B-GREAT is a feasible and reproducible method for bedside monitoring of the growth of the main brain structures in preterm neonates.

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Knowledge of Safety, Training, and Practice of Neonatal Cranial Ultrasound: A Survey of Operators

Abstract: There is a need to educate operators on biosafety issues and approaches to minimize power outputs and reduce the overall duration of cranial ultrasound scans. Development of standardized training requirements may be warranted.

Cited by 14 publications

References 41 publications

Transcranial Shear Wave Elastography of Neonatal and Infant Brains for Quantitative Evaluation of Increased Intracranial Pressure

Transcranial Shear Wave Elastography of Neonatal and Infant Brains for Quantitative Evaluation of Increased Intracranial Pressure

A Safety Study of the Effects of 2‐Dimensional Shear Wave Elastography on Synaptic Morphologic Characteristics and Function in the Hippocampus of Neonatal Mice

Brain Growth Evaluation Assessed with Transfontanellar (B-GREAT) Ultrasound. Old and New Bedside Markers to Estimate Cerebral Growth in Preterm Infants: a Pilot Study

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