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  • Title: Serial head ultrasound studies in preterm infants: how many normal studies does one infant need to exclude significant abnormalities?
    Author: Nwafor-Anene VN, DeCristofaro JD, Baumgart S.
    Journal: J Perinatol; 2003 Mar; 23(2):104-10. PubMed ID: 12673258.
    Abstract:
    OBJECTIVE: We hypothesized that preterm infants with two normal head ultrasound (HUS) screening studies > or = 7 days apart would have subsequently normal follow-up studies. POPULATION: We reviewed reports of all HUS studies performed in preterm infants < or = 32 weeks gestation admitted to our nursery between January 1998 and July 2000. SETTING: Regional perinatal referral center. DESIGN: A normal HUS screening study was defined as either no findings; or grade I intraventricular hemorrhage (IVH) (Papile classification), germinal matrix irregularity or cyst, or normal but unequal ventricular size. An abnormal study was defined as any with IVH > or = grade II, periventricular leukomalacia (PVL), ventriculomegaly (VM), or periventricular echogenicity (PVE). RESULTS: Of 98 infants, 92 infants (94%) who had two normal HUS studies > or = 7 days apart had normal repeat studies subsequently, and six (6%) were abnormal. Four of the six abnormal infants were <25 weeks gestation at birth. One infant (27 weeks) became abnormal after culture-positive bacterial sepsis and necrotizing enterocolitis with bowel perforation requiring surgery. The remaining infant (29 weeks) had a question of PVE, and a normal repeat study. The positive predictive value for having a normal HUS after two previously normal studies > or = 7 days apart was 94% with a specificity of 86%. CONCLUSION: Stable premature infants > or = 25 weeks gestation without intervening deterioration may not need repeat screening HUSs after having had two normal studies > or = 7 days apart. Unstable or extremely premature infants <25 weeks gestation may be subject to late severe IVH, VM, and PVL, and therefore need a repeat study before hospital discharge, even if two initial studies > or = 7 days apart were normal.
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