Ultrasound abnormalities preceding cerebral palsy in high-risk preterm infants.
OBJECTIVE
To assess sequential high-resolution cranial ultrasound (US) in high-risk preterm infants to predict cerebral palsy (CP).


METHODS
Preterm infants were prospectively studied (n=2139), 1636 <or=32 weeks gestational age (GA) (group A) and 503 with a GA of 33 to 36 weeks (group B). US was performed once a week until discharge and at 40 weeks postmenstrual age (PMA), using a 7.5-MHz transducer. Grade III and IV hemorrhage, cystic periventricular leukomalacia (c-PVL), and focal infarction were considered major US abnormalities. A diagnosis of CP was made at a minimum age of 24 months.


RESULTS
Seventy-six (5%) of the 1460 survivors in group A developed CP. US abnormalities were present in 70 of 76 (92%) infants, being major in 58 (83%) and minor in 12 (17%). In 29% of the CP cases with major US abnormalities, cysts were first detected beyond day 28. A further 6 infants without US abnormalities developed CP, and 3 of these infants developed ataxic CP. Twenty-nine (6%) of the 469 survivors in group B developed CP. US abnormalities were present in 28 of 29 (96%) infants, being major in 25 (89%) and minor in 3 (11%). One infant without US abnormalities developed CP. Considering the major US abnormalities, a specificity of 95% and 99% and a sensitivity of 76% and 86% were found for group A and B, respectively. The positive predictive value was 48% in group A and 83% in group B.


CONCLUSIONS
Seventy-nine percent of our CP cases had major US abnormalities. To detect c-PVL, the most predictive US marker for CP, sequential scans with a 7.5-MHz transducer are required.
De Vries
Linda S
LS
Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands. l.devries@wkz.azu.nl
Van Haastert
Inge-Lot C
IL
Rademaker
Karin J
KJ
Koopman
Corine
C
Groenendaal
Floris
F
D002547:Cerebral Palsy / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D004453:Echoencephalography; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007969:Leukomalacia, Periventricular / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D009426:Netherlands / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity