Predictability of cerebral palsy and its characteristics through neonatal cranial ultrasound in a high-risk NICU population

Abstract

The aim of the study is to evaluate the predictive value of various types of brain injury detected by ultrasound in the neonatal period for the occurrence of cerebral palsy and its characteristics in a large cohort of high-risk infants. Thousand twenty-one consecutively NICU-admitted high-risk infants were assessed up to the corrected age of at least 2 years. Cerebral palsy (CP) was categorised into spastic or non-spastic, bilateral or unilateral and mild, moderate or severe CP. Different types of brain injury were identified by serial cranial ultrasound (US) during the NICU stay: white matter disease (WMD), haemorrhage, cerebral infarction, deep grey matter and parasagittal cerebral injury. There is a significant overall association between different types of brain injury and gestational age. Only 4% of the children with normal US develop CP. In the presence of any abnormal US image, the likeliness to develop CP is at least seven times higher. Within the group of infants with WMD and haemorrhage, the degree of brain involvement has a clear impact on the occurrence of CP. Concerning the characteristics of CP, deep grey matter lesion predict non-spastic CP versus spastic CP (OR = 31, P < 0.001). Cerebral infarction and haemorrhage grade IV are strong predictors of unilateral spastic CP versus bilateral spastic CP (OR = 49 and 24, respectively, P < 0.001). Deep grey matter lesion is a significant predictor for severe versus mild and moderate CP (OR = 6). In conclusion, neonatal cranial US is a useful tool in predicting CP and its characteristics.

Perinatal Clinical Antecedents of White Matter Microstructural Abnormalities on Diffusion Tensor Imaging in Extremely Preterm Infants

“…This association was stronger than previously reported [7]. White matter injury on cranial ultrasound, a known risk factor for brain volume loss and developmental disabilities [26], was also an adverse antecedent in our preterm cohort. Similar to prior reports, we found a correlation between birth weight as well as longer duration of mechanical ventilation and DTI measures [25], [27].…”

The value of ultrasonography and Doppler sonography in prognosticating long-term outcomes among full-term newborns with perinatal asphyxia

“…According to the data of two studies conducted in Belgium by Himpens et al and published in 2010, any brain injury detected via USG (white matter injury, cerebral infarction, bruising, gray matter injury, or parasagittal white matter injury) increases the probability of CP by 7-fold. By applying the logistic regression model, the researchers found that HI injury to the thalamus and basal ganglia detected via USG increased the probability of spastic cerebral palsy by 31-fold (P < 0.001) [25,26].…”

Early Diagnosis and Early Intervention in Cerebral Palsy

“…Meta-analysis of six studies including over 2400 preterm infants on the power of neonatal cUS to predict CP indicated an estimated sensitivity of 74% and an estimated specificity of 92% (77). cUS may also assist prediction of the type and severity of CP (93). Unilateral infarctions are associated with unilateral spastic CP (but recall that this is not a one-to-one relationship!).…”

“…Unilateral infarctions are associated with unilateral spastic CP (but recall that this is not a one-to-one relationship!). Deep gray matter lesions are associated with dyskinetic CP and severe impairment (93). In case of PVL, cUS also serves the prediction of the ability to walk independently at the age of 2 years: children with grades I and II PVL usually are able to walk at age 2, whereas <10% of children with grade III (extensive PVL) are able to do so (38).…”