A comparision of linear-array and mechanical-sector cranial ultrasound scanning techniques to predict neurodevelopmental outcome at 8 years in preterm newborn infants

Long-term neurodevelopmental outcome of preterm children with unilateral cerebral lesions diagnosed by neonatal ultrasound

OBJECTIVE

Little information is available on long-term neurodevelopmental outcome of preterm infants with unilateral cerebral lesions detected by neonatal cranial ultrasound. This study aims to investigate the long-term outcome in a cohort of very preterm infants with unilateral cerebral lesions acquired in the perinatal period.

METHODS

A prospective cohort study of 668 preterm infants (<33 weeks gestation; birth years 1985-1991) at a single tertiary perinatal centre in the UK. All infants had serial cranial ultrasound examination in the neonatal period. Outcome was assessed at age 8 years with the Wechsler Intelligence Scales for Children (WISC-R), Test of Visuo-motor Integration (VMI) and the Test of Motor Impairment (TOMI).

RESULTS

Of the 668 infants, 369 infants had normal ultrasound scans. Two hundred and ninety nine children had bilateral parenchymal or non-parenchymal lesions (57 left-sided, 41 right-sided, 201 bilateral). Five hundred and thirty four (79%) children attended follow-up at age 8 years. Mean Full Scale IQ (FSIQ) was 101 (SD+/-16), 93 (SD+/-17), 102 (SD+/-17) and 91 (SD+/-21) for normal, left-sided, right-sided and bilateral lesion groups respectively. In all groups verbal IQ (VIQ) was higher than performance IQ (PIQ). Scores of FSIQ, VIQ and PIQ, VMI and TOMI were significantly different between the groups. After exclusion of children with parenchymal lesions, however, the difference was only significant for the TOMI scores. In all tests, children with left-sided lesions performed poorer than children with right-sided lesions.

CONCLUSIONS

In this cohort of preterm infants with unilateral cerebral lesions, verbal function was preserved over non-verbal function independently of the side of lesion. Furthermore, the results suggest that the neurodevelopmental outcome of children with left-sided lesions is less favourable than that of children with right-sided lesions.

Predictors of long-term outcome in very preterm infants: gestational age versus neonatal cranial ultrasound

OBJECTIVES

To investigate the effect of gestational age at birth on the frequency of ultrasound-detected brain lesions in infants born at <33 weeks of gestation and to investigate whether the relationship between neonatal cranial ultrasound diagnosis and neurodevelopmental outcome at 8 years of age was independent of gestational age.

METHODS

Eight hundred forty-seven infants born at <33 weeks of gestation, admitted to a single tertiary referral center between 1983 and 1988, underwent serial neonatal cranial ultrasound. At 8 years of age neurodevelopmental outcome was assessed by structured neurologic examination, psychometric tests (Wechsler Intelligence Scale for Children), tests of visuomotor integration (Beery) and motor impairment (Henderson-Stott). Infants were subdivided into a group born at <28 weeks and a group born at between 28 and 32 weeks. Neurodevelopmental outcome was analyzed for each ultrasound diagnosis.

RESULTS

Hemorrhagic lesions such as germinal matrix/intraventricular hemorrhage and hemorrhagic parenchymal infarction were more frequent in infants born at <28 weeks. There was no difference in the frequency of cystic periventricular leucomalacia between the 2 groups. When neurodevelopmental outcome for each ultrasound diagnosis was compared, no significant difference was found between the 2 gestational age groups.

CONCLUSION

In the gestational age range studied, adverse neurodevelopmental outcome depends primarily on the type of the intracranial lesion rather than on gestational age.