Abnormal head ultrasounds and neurodevelopmental outcome

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Severe intracranial hemorrhage and periventricular leukomalacia are believed to be strong predictors of poor neurodevelopmental outcome in extremely immature infants. The article by Broitman et al examines the ability of head ultrasounds, obtained during routine care to accurately predict neurodevelopmental outcomes. The authors compared the predictive capabilities of the commonly used ultrasound classification system (that considers increasing grades of IVH as a progression of a single disease) with clinical risk factors alone. Their study shows that head ultrasounds do not reliably predict neurodevelopmental impairment in survivors. When controlled for clinical variables and timing of the exam, only periventricular leukomalacia diagnosed closer to 36 weeks and shunt placement were significantly associated with subsequent neurodevelopmental impairment. Both the high prevalence of neurodevelopmental impairment in infants with no or minor grades of intracranial hemorrhage, and the frequent absence of severe impairment despite grade IV hemorrhage or periventricular leukomalacia, indicate that head ultrasound findings may not be as useful in predicting neurodevelopmental outcome as previously believed.

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