title: Preterm cranial ultrasound scanning is both feasible and effective in a middle-income country.
abstract: OBJECTIVE
  Cranial ultrasound is seldom used in middle-income countries, and the burden of preterm brain injury and its relationship to perinatal data is unknown. We assessed cranial ultrasound abnormalities in very low-birthweight (VLBW) infants and correlated the findings with perinatal data.
  
  
  METHODS
  VLBW Armenian infants receiving neonatal intensive care in 2012 were scanned from birth to term-equivalent age (TEA). Clinical data were collected prospectively.
  
  
  RESULTS
  We studied 100 VLBW infants with a median gestation of 30 weeks. Periventricular white matter echogenicity (PVE) lasting more than two weeks was seen in 34 infants, grade III intraventricular haemorrhage (IVH) in 10, haemorrhagic parenchymal infarction (HPI) in seven and cystic periventricular leukomalacia in two. Caudothalamic notch echogenicity appeared in 36 infants after two to three weeks, with cystic transformation in 22. At TEA, 17 infants had persisting PVEs and 55 had increased basal ganglia/thalamic (BGT) echogenicity. Lack of antenatal steroids was significantly associated with IVH and HPI and intubation at birth with IVH. Late BGT echogenicity was generally seen in infants without perinatal problems.
  
  
  CONCLUSIONS
  Our study demonstrated that cranial ultrasound can be used effectively in a middle-income country to identify high-risk infants and monitor quality of care.
authors.affiliation: Research Centre of Maternal and Child Health Protection, Yerevan, Armenia.|Department of Neonatology, Yerevan State Medical University, Yerevan, Armenia.
authors.forename: Pavel A
authors.initials: PA
authors.lastname: Mazmanyan
authors.affiliation: Department of Neonatology, Yerevan State Medical University, Yerevan, Armenia.
authors.forename: Knarik V
authors.initials: KV
authors.lastname: Nikoghosyan
authors.affiliation: Research Centre of Maternal and Child Health Protection, Yerevan, Armenia.|Department of Neonatology, Yerevan State Medical University, Yerevan, Armenia.
authors.forename: Varsenik V
authors.initials: VV
authors.lastname: Kerobyan
authors.affiliation: BirthLink, London, UK.
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Mellor
authors.affiliation: Department of Biostatistics, La Paz University Hospital, Madrid, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Diez-Sebastian
authors.affiliation: Department of Paediatrics, Imperial College London, London, UK.
authors.forename: Miriam
authors.initials: M
authors.lastname: Martinez-Biarge
authors.affiliation: Department of Paediatrics, Imperial College London, London, UK.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
mesh_terms: D001238:Asphyxia Neonatorum / Q000000981:diagnostic imaging; D001921:Brain / Q000000981:diagnostic imaging*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data*; D008297:Male; D014463:Ultrasonography / Q000706:statistics & numerical data*
keywords: Cranial ultrasound imaging; Intraventricular haemorrhage; Middle-income country; Neonatal intensive care; Preterm