title: Cranial ultrasound lesions in the NICU predict cerebral palsy at age 2 years in children born at extremely low gestational age.
abstract: Our prospective cohort study of extremely low gestational age newborns evaluated the association of neonatal head ultrasound abnormalities with cerebral palsy at age 2 years. Cranial ultrasounds in 1053 infants were read with respect to intraventricular hemorrhage, ventriculomegaly, and echolucency, by multiple sonologists. Standardized neurological examinations classified cerebral palsy, and functional impairment was assessed. Forty-four percent with ventriculomegaly and 52% with echolucency developed cerebral palsy. Compared with no ultrasound abnormalities, children with echolucency were 24 times more likely to have quadriparesis and 29 times more likely to have hemiparesis. Children with ventriculomegaly were 17 times more likely to have quadriparesis or hemiparesis. Forty-three percent of children with cerebral palsy had normal head ultrasound. Focal white matter damage (echolucency) and diffuse damage (late ventriculomegaly) are associated with a high probability of cerebral palsy, especially quadriparesis. Nearly half the cerebral palsy identified at 2 years is not preceded by a neonatal brain ultrasound abnormality.
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston University, Boston, Massachusetts, USA. karl.kuban@bmc.org
authors.forename: Karl C K
authors.initials: KC
authors.lastname: Kuban
authors.forename: Elizabeth N
authors.initials: EN
authors.lastname: Allred
authors.forename: T Michael
authors.initials: TM
authors.lastname: O'Shea
authors.forename: Nigel
authors.initials: N
authors.lastname: Paneth
authors.forename: Marcello
authors.initials: M
authors.lastname: Pagano
authors.forename: Olaf
authors.initials: O
authors.lastname: Dammann
authors.forename: Alan
authors.initials: A
authors.lastname: Leviton
authors.forename: Adré
authors.initials: A
authors.lastname: Du Plessis
authors.forename: Sjirk J
authors.initials: SJ
authors.lastname: Westra
authors.forename: Cindy R
authors.initials: CR
authors.lastname: Miller
authors.forename: Haim
authors.initials: H
authors.lastname: Bassan
authors.forename: Kalpathy
authors.initials: K
authors.lastname: Krishnamoorthy
authors.forename: Joseph
authors.initials: J
authors.lastname: Junewick
authors.forename: Nicholas
authors.initials: N
authors.lastname: Olomu
authors.forename: Elaine
authors.initials: E
authors.lastname: Romano
authors.forename: Joanna
authors.initials: J
authors.lastname: Seibert
authors.forename: Steve
authors.initials: S
authors.lastname: Engelke
authors.forename: Padmani
authors.initials: P
authors.lastname: Karna
authors.forename: Daniel
authors.initials: D
authors.lastname: Batton
authors.forename: Sunila E
authors.initials: SE
authors.lastname: O'Connor
authors.forename: Cecelia E
authors.initials: CE
authors.lastname: Keller
mesh_terms: D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000473:pathology; D002547:Cerebral Palsy / Q000175:diagnosis* / Q000209:etiology; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D002658:Developmental Disabilities / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006257:Head / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008279:Magnetic Resonance Imaging; D008297:Male; D009043:Motor Activity / Q000502:physiology; D009460:Neurologic Examination / Q000379:methods; D011597:Psychomotor Performance / Q000502:physiology; D014463:Ultrasonography