Neurosonogram in Critically Ill Neonates in Neonatal Intensive Care Unit

Aim: Neonates born prematurely and sick full-term neonates are at risk of brain injury. Although advances in neonatal intensive care have greatly improved the survival and outcome of these vulnerable patients, brain injury remains of major concern. Early diagnosis is important for prognostication, optimal treatment, and predicting the neurological outcome. Objective: This study was done to describe the pattern of cranial ultrasound abnormalities in preterm and term critically ill neonates in neonatal intensive care unit (NICU). Materials and Methods: This prospective observational clinical study was done in Vydehi Institute of Medical Sciences Hospital and Research Centre, Bengaluru between January 2014 and July 2015. After obtaining informed consent 100 critically ill neonates admitted to our NICU were included in this study. History and clinical examination followed by appropriate investigations were done. These critically ill neonates were subjected to neurosonography on selected days as per as protocol and different patterns of morphology abnormalities were noted. Clinical correlation with neurosonogram findings was observed and if found abnormal follow-up neurosonogram were done. Results: The incidence of neurosonographic abnormalities in high-risk neonates is 31% in the present study. Of these 41% of these had evidence of intracranial bleed, 25% had cerebral edema, 6% periventricular leukomalacia, 16% hyperechogenic thalami, and one had ventriculomegaly. Of the 31% of neonates with abnormal findings on neurosonogram, 22% had hypoxicischemic encephalopathy as per Apgar scoring, 25% had features of sepsis. One neonates with intraventricular bleed on regular follow-up of neurosonogram developed ventriculomegaly. Conclusion: This study signifies the importance of neurosonogram in critically ill neonates as diagnostic tool and as screening modality in NICU. It also emphasizes its use as a screening modality for preterm and birth asphyxia neonates influencing their neurodevelopmental outcome. Neurosonogram is critical as an investigatory modality in NICU for early, safe and easy diagnostic tool for predicting the neurological damage for management in NICU and predicting outcome.