Neonatal Cranial Ultrasound Findings Among Infants Born Extremely Preterm: Associations With Neurodevelopmental Outcomes at Ten Years of Age

OBJECTIVE: To examine the association between neonatal cranial ultrasound abnormalities among infants born extremely preterm and neurodevelopmental outcomes at ten years of age. STUDY DESIGN: In a multi-center birth cohort of infants born at < 28 weeks’ gestation, 889 of 1198 survivors were evaluated for neurological, cognitive, and behavioral outcomes at 10 years of age. Sonographic markers of white matter damage (WMD) included echolucencies in the brain parenchyma and moderate to severe ventricular enlargement. Neonatal cranial ultrasound findings were classified as: intraventricular hemorrhage (IVH) without WMD, IVH with WMD, WMD without IVH, and neither IVH nor WMD. RESULTS: WMD without IVH was associated with an increased risk of cognitive impairment (OR 3.5, 95% CI 1.7, 7.4), cerebral palsy (OR 14.3, 95% CI 6.5, 31.5), and epilepsy (OR 6.9; 95% CI 2.9, 16.8). Similar associations were found for WMD accompanied by IVH. Isolated IVH was not significantly associated these outcomes. CONCLUSIONS: Among children born extremely preterm, cranial ultrasound abnormalities, particularly those indicative of WMD, are predictive of neurodevelopmental impairments at 10 years of age. The strongest associations were found with cerebral palsy.