Neonatal Neurosonography

Abstract

Neonatal neurosonography is used commonly to evaluate the central nervous system in the neonatal intensive care setting. The procedure can be performed at the bedside in these critically ill patients who may suffer from hemodynamic and thermoregulatory instability and often require mechanical ventilation. This article reviews current recommendations regarding neurosonography technique, pathophysiology, and imaging of intracranial insults including hemorrhage, white matter injury, infarction, and hypoxic-ischemic encephalopathy.

Neonatal Cranial Ultrasound: Advanced Techniques and Image Interpretation

“…In contrast, coronal and sagittal images through the anterior fontanel performed with a high-frequency linear transducer (9 MHz or more) allows better resolution and more detailed visualization of structures in the near field and midline. [2][3][4][5] This technique allows optimal evaluation of the deep gray structures of the basal ganglia, lateral ventricles, and periventricular white matter and allows more detailed assessment of gray-white matter differentiation in the cortex and subcortical white matter (►Fig. 1).…”

“…Over the first year of life, RI in the ACA will continue to decrease to a normal value of 0.6 in children aged 1 year and eventually reaches a normal value of 0.45 to 0.6 in children aged >2 years. 2,[7][8][9] The ACA RI will demonstrate changes in response to alterations in end-diastolic flow. For example, cerebral vascular dilatation in the setting of acute hypoxia or ischemia will result in increased end-diastolic flow generating a lower ACA RI (►Fig.…”

“…The GM reaches maximal volume at 24 to 26 weeks' gestation and then regresses over the next 10 weeks with only scattered areas of residual GM seen in the caudothalamic groove at 36 to 38 weeks' gestation. 2 The GM is highly vascular, supplied by a network of fragile capillaries originating from the recurrent artery of Hubner and from penetrating striate and anterior choroidal arteries. 2,11 Fluctuations in systemic blood pressure and alterations in oxygenation, especially in the presence of increased venous pressure, lead to rupture of the fragile GM capillaries with resultant hemorrhage.…”

“…1 Cine clips, in addition to representative still images, are helpful as complex or subtle findings may be better appreciated in the "real-time scanning" context. 2,3 Advanced Techniques in Neonatal Cranial Ultrasound…”

Cerebral White Matter Injuries Following a Hypoxic/Ischemic Insult During the Perinatal Period: Pathophysiology, Prognostic Factors, and Future Strategy of Treatment Approach. A Minireview

“…Multiple single, and multi-centre studies reported an association between cranial US findings and adverse neurodevelopmental outcomes [93][94][95]. The strongest predictors of subsequent cerebral palsy visualised on US are ventriculomegaly and white matter echolucencies [96]. Application of advanced techniques, including the use of high-resolution linear transducers and Doppler assessment of intracranial vasculature, assist in maximizing the value of this important tool [97].…”