Neonatal Brain Ultrasound: procedure of a cranial ultrasound in neonates

Medically reviewed: 24, January 2024

Cranial Ultrasound in Neonates

Neonatal brain ultrasound is a crucial tool used by healthcare professionals to assess the development and health of a newborn’s brain. These non-invasive tests use sound waves to create images of the brain, allowing doctors to detect any abnormalities or issues that may require further investigation or treatment.

An explanation of neonatal brain ultrasound

Ultrasound technology has been widely used in obstetrics and gynecology for several decades, but its application in neonatology has only become more prevalent in recent years. During a neonatal brain ultrasound, a small probe called a transducer is placed on the baby’s skull, emitting high-frequency sound waves that bounce off the structures inside the brain. The resulting echoes are then converted into visual images, which can be analyzed by medical experts.

The benefits of using ultrasound technology include its non-invasiveness, lack of radiation exposure, and relatively low cost compared to other imaging techniques such as CT scans or MRIs. Additionally, because ultrasound do not require sedation or anesthesia, they can be easily repeated if necessary, providing ongoing monitoring of the baby’s brain development.

Neonatal brain ultrasound is a quick and informative method for examining the structures of the brain in children under one year old. It allows you to visualize the child’s brain through an open large anterior fontanel. Ultrasonography of the brain can be used in adults with defects in the bones of the skull as a result of injuries or surgeries, if these holes can be used instead of the open fontanelle. This method of examination is preliminary, in the detection of pathology, a follow-up examination of the patient (CT or MRI) is necessary.

Key Points About Neonatal Brain ultrasound

1. Non-invasive nature: As highlighted earlier, ultrasound examinations present minimal risk compared to alternative methods, rendering them an ideal first-line approach for assessing infant brains. Devoid of radiation exposure or sedation requirements, this modality offers unparalleled accessibility without compromising accuracy.
2. Timing considerations: We delved into the importance of timing in obtaining optimal results, emphasizing critical windows during which distinct physiological changes unfold. Early assessment facilitates prompt detection and intervention for emergent conditions, ensuring improved clinical trajectories.
3. Anatomical landmarks: Familiarization with relevant anatomy forms the foundation upon which accurate interpretations rest. Identification of key structures allows practitioners to discern normal variants from aberrancies, thereby driving informed decision-making processes.
4. Classification systems: Established grading schemes enable standardized reporting and comparisons across institutions, streamlining collaborative efforts and enhancing consistency in management approaches. These frameworks prove instrumental in forecasting prognoses and tailoring interventions according to severity levels.
5. Clinical correlations: Linking observed radiologic findings to anticipated clinical consequences remains paramount in devising effective care plans. Understanding how structural alterations translate into functional limitations equips healthcare providers with vital insights needed to navigate complex scenarios confidently.
6. Multidisciplinary collaboration: Harnessing collective expertise through cross-functional partnerships amplifies diagnostic acumen and expands available resources for patients and families alike. Leveraging specialized knowledge ensures comprehensive coverage of evolving needs while nurturing robust networks of support.
7. Ongoing advancements: Technological innovations continue to shape the field of neonatal neuroimaging, pushing boundaries of what is feasible and expanding horizons for novel discoveries. Remaining abreast of burgeoning trends keeps practitioners at the forefront of progress, poised to integrate breakthroughs into routine practice.
8. Patient-centered focus: Amidst technological marvels and scientific strides, it is crucial never to lose sight of the human element underpinning every interaction. Prioritizing empathy, clear communication, and resource stewardship fosters enduring bonds built on mutual respect and shared goals.

The importance of early detection and diagnosis

Early detection and diagnosis of potential brain abnormalities in newborns can have significant impacts on their long-term outcomes. Identifying issues early on allows for prompt intervention and treatment, which can help minimize damage and improve prognosis.

For example, babies born prematurely are at higher risk for developing intraventricular hemorrhage (bleeding in the brain) or periventricular leukomalacia (white matter injury). Early identification of these conditions through neonatal brain ultrasound enables healthcare providers to take appropriate action, potentially reducing the severity of symptoms and improving overall neurological function.

Moreover, some congenital brain malformations may not present immediate symptoms but can lead to developmental delays or disabilities later in life. By identifying these conditions early, families can access resources and support services tailored to their child’s needs, ensuring optimal growth and development.

Benefits of using ultrasound technology

Ultrasonography offers numerous advantages over alternative imaging techniques, rendering it a preferred choice for many clinical scenarios involving newborns. Key benefits include:

1. Non-ionizing: Unlike computed tomography (CT) and magnetic resonance imaging (MRI), ultrasound does not utilize ionizing radiation or strong magnetic fields, reducing potential harm to fragile developing brains.
2. Accessibility: Portable ultrasound machines enable bedside assessments, streamlining workflows and expediting diagnoses without necessitating transport to radiology departments.
3. Cost-effectiveness: Compared to CT and MRI, ultrasound remains more economical, offering comparable diagnostic accuracy at lower financial burdens.
4. Real-time imaging: Ultrasound allows dynamic evaluation of moving structures, providing immediate feedback regarding blood flow, vessel patency, and tissue perfusion.
5. Safety: Lacking invasive components, ultrasound poses minimal risk of adverse events, enabling repeated assessments if needed.

Comparison to other imaging techniques

While both CT and MRI offer superior spatial resolution compared to ultrasound, each modality carries distinct drawbacks that limit their applicability in neonatal settings.

For instance, CT exposes patients to ionizing radiation, increasing cancer risks; meanwhile, MRI requires extended scan times and specialized equipment, restricting availability and practicality. Conversely, ultrasound boasts unparalleled convenience, safety, and cost-efficiency, solidifying its position as a cornerstone in neonatal neuroimaging.

When Are Neonatal Brain ultrasound Performed?

Understanding when neonatal brain ultrasound should be conducted is essential for ensuring timely detection and diagnosis of potential brain abnormalities in newborns. In this section, we will discuss the definition of high-risk newborns, common reasons for performing a neonatal brain ultrasound, and the typical timeline for these procedures.

The timing of neonatal brain ultrasound depends on several factors, including the reason for the scan and the infant’s age at birth. Generally, ultrasound are categorized into three timeframes based on when they are most commonly performed:

• Initial or “bedside” ultrasound: Typically conducted within the first few days of life, this initial scan serves as a baseline assessment of the brain’s structure and appearance. It helps identify gross abnormalities like large cysts, hematomas, or hydrocephalus.
• Intermediate or “follow-up” ultrasound: Depending on the results from the bedside ultrasound, follow-up scans may be scheduled between one to two weeks after birth. These evaluations allow physicians to track changes over time and ensure proper brain development.
• Late or “terminal” ultrasound: Performed around 36 to 40 weeks of gestational age (or equivalent corrected age for preterm infants), terminal ultrasound provide a final assessment before discharge from the hospital. They serve to confirm previous findings, evaluate resolution of earlier identified lesions, and screen for late-developing abnormalities.

Indications and contraindications for neonatal brain ultrasound

The examination is shown for premature newborns, children with signs of disorders of the nervous system, who have suffered a brain injury (including a birth injury) or hypoxic damage to the central nervous system. Clinical neurology uses neonatal brain ultrasound as a screening method for mass screening for the early detection of congenital CNS pathology, which enables timely treatment, increase its effectiveness and avoid complications.

Neonatal brain ultrasound screening is most important in children under 3 months of age, when pathological changes that are not diagnosed at birth are possible (for example, slowly progressing hydrocephalus, gradually increasing cysts of the brain).

Ultrasonography is prescribed by a neurologist for emergency rapid diagnosis of the nature and location of pathological changes in the brain, if it is impossible to examine with CT-scan or MRI (lack of equipment, severe condition of the child, lack of time, etc.).

It is used for monitoring and evaluation in the dynamics of the state intracranial structures. This is necessary for frequent repeated examinations of a patient with a diagnosis confirmed on CT or MRI, after neurosurgical operations, in the treatment of hydrocephalus and other diseases.

During neurosurgical operations or diagnostic punctures of the intracerebral formations (abscess, cyst, swelling, etc.), ultrasonographic neuronavigation is used, which allows manipulation in the cranial cavity under visual control.

Contraindication is the presence of severe deformities of the skull in the anterior fontanel and temporal bones, which makes it difficult to conduct neonatal brain ultrasound and can distort its results.

High-risk newborns are infants who face increased chances of complications during birth or immediately afterward due to various factors. Some common characteristics of high-risk newborns include:

• prematurity,
• low birth weight,
• multiple gestations,
• fetal distress,
• respiratory distress syndrome,
• congenital heart defects,
• and genetic disorders.

Newborns with these traits often undergo additional testing, including neonatal brain ultrasound, to monitor their progress and identify any potential concerns.

Common reasons for performing a neonatal brain ultrasound

Several indicators warrant the performance of a neonatal brain ultrasound. These may include:

1. Abnormal head circumference measurements: Significantly larger or smaller than average head sizes might suggest underlying brain abnormalities.
2. Seizures: Infants experiencing seizures may require urgent evaluation to determine whether there is a structural cause within the brain.
3. Hydrocephalus: This condition involves excessive accumulation of cerebrospinal fluid in the ventricles of the brain, leading to enlargement of the head.
4. Suspected infection: Meningitis or encephalitis can affect the brain, necessitating thorough examination via ultrasound.
5. Prematurity: Preterm infants are particularly susceptible to brain injuries such as intraventricular hemorrhages and white matter damage.
6. Birth asphyxia: Prolonged oxygen deprivation during labor and delivery can result in hypoxic-ischemic encephalopathy, requiring close monitoring.
7. Genetic syndromes: Certain genetic disorders carry heightened risks for brain anomalies, making ultrasound screening valuable.
8. Abnormal neurological examinations: If a physical assessment reveals concerning signs, such as poor muscle tone or reflexes, further investigation with an ultrasound may be required.

Neonatal brain ultrasound: Method of conducting

Examination does not require the preparation of a child. It is carried out according to the method of conventional ultrasound examination in three different ways:

• through the open anterior fontanelle (over-epoch ultrasonography),
• through the temporal and other bones of the skull (transcranial ultrasonography),
• by combining the first two methods (transcranial ultrasound ultrasonography).

Since dense skull bones poorly pass ultrasonic signals, the examination is traditionally carried out through the anterior fontanel. However, it does not allow you to fully view the entire space inside the skull.

The accessibility of the study of these or other brain structures depends on the size of the fontanel and their remoteness from it. In this case, areas that are located under the bones of the cranial vault and the posterior parts of the brain are often not examined.

For their study, transcanial ultrasonography is used. It is carried out in places where the bones of the skull are thinner and let in ultrasound, for example, the scales of the temporal bone, the bones in place of the closed lateral fontanels (anterior located in front of the ear, and the posterior behind the ear). In addition, it is possible to use a large occipital opening.

To do this, head the child as much as possible forward to the chest, and the ultrasonic sensor is installed under the back of the head. The combined use of overgrowth and transcranial ultrasonography makes it possible to obtain the most complete information about the structures of the brain and pathological changes in them.

Neonatal brain ultrasound step by step

The examination lasts 5-15 minutes. In rare cases, during ultrasonography, false positive results can be obtained that are not confirmed by a pre-examination on a tomograph, or false-negative results-unidentified pathological abnormalities.

The procedure itself is non-invasive, painless, and devoid of radiation exposure – qualities that render it an attractive option for pediatric populations. To perform a neonatal brain ultrasound, a trained sonographer follows these steps:

1. Positioning: The infant lies supine with their head slightly elevated. Ensuring adequate warmth and comfort facilitates optimal image acquisition while minimizing stress.
2. Application of gel: A water-based conductive medium is applied to the anterior fontanelle – a soft spot located on top of the baby’s skull where bones have yet to fuse completely. This region serves as an ideal acoustic window, allowing easy access to the underlying brain tissue.
3. Transducer placement: An ultrasound probe containing piezoelectric crystals is gently placed against the gel-covered fontanelle. As the transducer transmits sound waves through the skull, echoes bounce back, capturing cross-sectional images of the brain.
4. Image interpretation: Sonographers analyze the resulting grayscale images, assessing key structures such as the lateral ventricles, thalami, basal ganglia, and cortex. Any notable variations from normal appearances prompt further investigation or referral to a specialist.

Interpreting Results of a Neonatal Brain Ultrasound

Neonatal brain ultrasound can reveal various intracranial features, ranging from typical developmental patterns to concerning anomalies requiring follow-up evaluations. Familiarizing oneself with common findings empowers parents and caregivers to engage actively in shared decision-making processes surrounding their child’s health. Some possible outcomes include:

• Normal appearance: Ideally, an ultrasound examination will yield images depicting well-defined structures within expected size ranges, signaling healthy brain growth and organization.
• Germinal matrix hemorrhage (GMH): GMH refers to bleeding within the germinal matrix, a highly vascularized area responsible for generating neurons during fetal life. Depending on severity, GMH may progress to intraventricular hemorrhage (IVH). Grades I-II generally carry favorable prognoses, whereas grades III-IV often entail long-term neurologic sequelae.
• Intraventricular hemorrhage (IVH): IVH denotes accumulation of blood within the cerebral ventricles, frequently arising secondary to GMH. Similar to GMH, IVH grading informs management strategies and predicts functional outcomes.
• Periventricular leukomalacia (PVL): PVL indicates injury to white matter tracts surrounding the lateral ventricles, typically occurring due to hypoxia-ischemia or infection. Severe cases can manifest as motor deficits, cognitive impairment, or vision loss.
• Cerebellar lesions: Abnormalities affecting the cerebellum, such as infarcts or hemorrhages, might portend poor coordination, balance issues, or speech difficulties.
• Structural malformations: Congenital defects like agenesis of the corpus callosum, holoprosencephaly, or Dandy-Walker syndrome warrant multidisciplinary collaboration among specialists to optimize interventions and support systems.

Follow-Up Steps After Receiving Results

Depending on identified findings, appropriate courses of action vary. Generally, recommendations encompass close monitoring, therapeutic interventions, and repeat imaging studies. Specific examples include:

1. Routine checkups: Regular developmental screenings ensure timely identification of emerging concerns, permitting early intervention when necessary.
2. Targeted therapies: Occasionally, pharmaceuticals or surgical procedures address specific conditions detected via ultrasound examinations. Examples include anticonvulsant medications for seizure control, shunt placements for hydrocephalus management, or laser coagulation of retinal vessels in cases of retinopathy of prematurity.
3. Additional imaging: Subsequent scans, including MRIs, provide enhanced detail about suspected pathologies, refining prognostication efforts and guiding subsequent treatment plans.

Role of Healthcare Providers in Explaining Results and Next Steps

Navigating complex medical jargon and deciphering nuanced implications represents a formidable challenge for most families. Expertly trained healthcare professionals serve pivotal roles in translating technical language into accessible concepts, fostering understanding amidst uncertainty. Critically important tasks comprise:

• Clear communication: Delivering bad news demands tact, compassion, and patience. Adapting explanatory styles based on individual preferences enables comprehension across diverse backgrounds.
• Empowerment: Encouraging active participation in decision-making processes bolsters self-efficacy, promoting resilience throughout challenging journeys.
• Resource allocation: Connecting families with reputable organizations, educational materials, and supportive services alleviates feelings of isolation and despair.
• Emotional validation: Recognizing emotional responses to distressing information validates personal experiences, cultivating trust between clinicians and those they serve.

Ultrasound of the brain: cost in USA

The study belongs to the category of inexpensive diagnostic manipulation, conducted in specialized medical institutions. Usually in USA state clinics and hospitals prices for ultrasound of the brain are more accessible than in private medical-diagnostic centers.

The technique is often used for emergency indications, which can influence pricing. When carrying out operations on the brain and puncturing intracerebral formations using ultrasonographic neuronavigation, the total cost of the procedure is calculated taking into account the price of the intervention.