Utility of Serial Cranial Ultrasound in Preterm Infants

Abstract

Objective

This study aimed to describe and evaluate our single-center practice of serial cranial ultrasound (CUS) in preterm infants following the 2020 American Academy of Pediatrics (AAP) clinical report. To evaluate the rate of cranial abnormalities following the first normal scan and identify risk factors for severe intraventricular hemorrhage (IVH) in the first week of life.

Study Design

A single-center retrospective study over an 8-year study period, from 2016 to 2023. Rates and types of CUS are described and compared over pre- and post-AAP clinical report time epochs. Risk factors associated with severe IVH were analyzed with logistic regression.

Results

A total of 727 infants were included. Median number of CUS was 3 (IQR: 2, 4) in both pre- and post-AAP cohort periods. CUS were performed in 289 (39.8%) infants before 7 days of life (DOL), 595 (81.8%) at 7 to 10 DOL, 623 (85.7%) at 4 to 6 weeks, and 361 (49.7%) at term equivalent age (TEA). The rates of abnormal CUS were 139 (48.1%), 364 (61.2%), 401 (64.4%), and 227 (62.9%) of the infants who had CUS at less than 7 days, 7 to 10 days, 4 to 6 weeks, and TEA, respectively. New abnormalities were detected in 13% (48/364) of infants following a normal 7 to 10 DOL scan and 3% (9/290) following a normal 7 to 10 days and 4 to 6 weeks scan. Decreased birth gestational age (odds ratio [OR] = 0.7), advanced resuscitation (OR = 3.4), and birth at outside hospital (OSH; OR = 2.6) were associated with severe IVH before 7 DOL.

Conclusion

Our single-center practice of serial CUS was largely consistent with the AAP clinical report. We report that new findings of abnormality following a normal 7 to 10 DOL scan are infrequent and predominantly limited to grade 1 IVH and benign cysts. We identified birth gestation below 25 weeks, birth at an OSH, and advanced resuscitation as risk factors for severe IVH.

Key Points

• Our single center practice of serial cranial ultrasound was largely consistent with the AAP policy statement.

• New abnormal findings after a normal 7-10 cranial ultrasound.

• Lower gestational age and advanced resuscitation at birth and transfer from outside hospital increased risk for severe IVH.

Keywords

preterm infants - cranial ultrasound - intraventricular hemorrhage - periventricular leukomalacia

Publication History

Received: 01 September 2025

Accepted: 24 December 2025

Accepted Manuscript online:
30 December 2025

Article published online:
14 January 2026

• References

• 1 Nagy Z, Obeidat M, Máté V. et al. Occurrence and time of onset of intraventricular hemorrhage in preterm neonates: a systematic review and meta-analysis of individual patient data. JAMA Pediatr 2025; 179 (02) 145-154
• 2 Rees P, Callan C, Chadda KR. et al. Preterm brain injury and neurodevelopmental outcomes: a meta-analysis. Pediatrics 2022; 150 (06) e2022057442
• 3 Inder TE, Volpe JJ, Anderson PJ. Defining the neurologic consequences of preterm birth. N Engl J Med 2023; 389 (05) 441-453
• 4 Paneth N, Pinto-Martin J, Gardiner J. et al. Incidence and timing of germinal matrix/intraventricular hemorrhage in low birth weight infants. Am J Epidemiol 1993; 137 (11) 1167-1176
• 5 Payne AH, Hintz SR, Hibbs AM. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental outcomes of extremely low-gestational-age neonates with low-grade periventricular-intraventricular hemorrhage. JAMA Pediatr 2013; 167 (05) 451-459
• 6 Hand IL, Shellhaas RA, Milla SS. Committee on Fetus and Newborn, Section on Neurology, Section on Radiology. Routine neuroimaging of the preterm brain. Pediatrics 2020; 146 (05) e2020029082
• 7 Mohammad K, Scott JN, Leijser LM. et al. Consensus approach for standardizing the screening and classification of preterm brain injury diagnosed with cranial ultrasound: a Canadian perspective. Front Pediatr 2021; 9: 618236
• 8 Dudink J, Jeanne Steggerda S, Horsch S. eurUS.brain group. State-of-the-art neonatal cerebral ultrasound: technique and reporting. Pediatr Res 2020; 87 (Suppl. 01) 3-12
• 9 Inder TE, de Vries LS, Ferriero DM. et al. Neuroimaging of the preterm brain—review and recommendations. J Pediatr 2021; 237: 276-287.e4
• 10 McLean G, Ditchfield M, Paul E, Malhotra A, Lombardo P. Evaluation of a cranial ultrasound screening protocol for very preterm infants. J Ultrasound Med 2023; 42 (05) 1081-1091
• 11 Ramdass S, Disher T, Vincer M, Afifi J, Ahmad T. Re-evaluating the timing of sequential cranial ultrasound screening in very preterm infants for predicting neurodevelopmental outcomes. Pediatr Radiol 2025; 55 (01) 173-182
• 12 Liu AR, Gano D, Li Y, Diwakar M, Courtier JL, Zapala MA. Rate of head ultrasound abnormalities at one month in very premature and extremely premature infants with normal initial screening ultrasound. Pediatr Radiol 2022; 52 (06) 1150-1157
• 13 Bassan H, Feldman HA, Limperopoulos C. et al. Periventricular hemorrhagic infarction: risk factors and neonatal outcome. Pediatr Neurol 2006; 35 (02) 85-92
• 14 Szpecht D, Szymankiewicz M, Nowak I, Gadzinowski J. Intraventricular hemorrhage in neonates born before 32 weeks of gestation-retrospective analysis of risk factors. Childs Nerv Syst 2016; 32 (08) 1399-1404