Cranial ultrasound at 6 weeks postnatal age versus term equivalent age in high-risk pre-term infants: a prospective cohort study.

Abstract

OBJECTIVE: To determine whether cranial ultrasound (cUS) at term equivalent age (TEA) provides additional diagnostic information compared with routine imaging at 6 wk postnatal age (PNA) in high-risk pre-term infants. METHOD(S): A prospective cohort study at a tertiary neonatal intensive care unit in Melbourne, Australia, was carried out. Sixty-nine pre-term neonates born <32 wk gestation or <1500 g, with one or more clinical risk factors for brain injury, underwent cUS at both 6 wk PNA and TEA. Imaging findings were classified as normal or abnormal, and changes over time were categorised as stable, resolved or new. RESULT(S): cUS brain abnormalities were identified in 70% of infants at 6 wk PNA and 90% at TEA (p = 0.001), representing a significant increase in detection. Findings remained stable in 58% of cases; 38% had new abnormalities at TEA, including ventricular enlargement, widened interhemispheric fissures and parenchymal injury. Complete resolution was seen in only 4%. CONCLUSION(S): Cranial ultrasound at TEA significantly improved the detection of potential brain injury compared with 6 wk PNA imaging. These findings support consideration of TEA as the preferred timing for final screening, potentially replacing the 6 wk PNA scan, although larger studies are needed to confirm optimal practice.Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.