ULTRASOUND EVALUATION OF SUBEPENDYMAL AND INTRAVENTRICULAR HEMORRHAGE IN THE PREMATURE INFANT

Abstract

The incidence of subependymal germinal matrix bleed with possible subsequent intraventricular hemorrhage (IVH) is a significant cause of morbidity and mortality in the premature infant. IVH may occur in 1/3 to 1/2 of all premature infants. CT is an invaluable tool for evaluating the suspected infant, however, the need to remove the newborn from its protective environment is a serious drawback. Ultrasound provides a uniquely flexible, accurate, and safe means for evaluating the newborn premature infant.

The ultrasound examinations were performed using either a portable linear array scanner or a portable sector real-time unit. Coronal, axial, and sagittal views were obtained. Infants who were determined to be stable enough for transport received CT examinations for correlation.

Sixty-five premature infants were evaluated with ultrasound for a total of 100 examinations. Thirty CT studies were performed in twenty-two of the infants. A linear array real-time ultrasound unit was used in forty-seven studies and a rotating head sector real-time unit was used in fifty-three studies.

Ultrasound scanning, both linear and sector, has been found to be as accurate as CT in the detection of ventricular enlargement. Sector ultrasound is as sensitive as CT in determining germinal matrix hemorrhage, but has a significant advantage over CT since it can be performed as a portable exam without removing the infant from its isolette. Because serial studies are easily done with ultrasound, the developmental sequence of IVH can be followed. This often includes the formation of clots and septations within the ventricles which because they are often isodense cannot be seen with CT.