Cranial Ultrasound Scanning in the Newborn Infant

Publication: 28/06/2018  --
Last review: 28/06/2018  
Next review: 28/06/2021  
Clinical Guideline
CURRENT 
ID: 4328 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2018  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Cranial Ultrasound Scanning in the Newborn Infant

Summary of Guideline

Preterm and sick newborn infants are at risk of brain injury. Cranial ultrasound (Cr USS) can be used to help in the diagnosis. 

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Background

  • Neonates less than 30 weeks gestation are at greatest risk of intraventricular haemorrhage (IVH) or periventricular leucomalacia (PVL).
  • 90% of IVH occur within first 72 hours.
  • Periventricular increased echogenicity is more significant if persists > 7 days
  • Parenchymal changes visible by 4-6 weeks

Babies over 32+0 weeks or more do not require routine ultrasound. Occasionally there will be a clinical indication to perform a Cr USS outside protocol.

As with every guideline, it is a guide and the clinical situation may warrant deviation from these guidelines. The radiology team are very happy to discuss babies that may need additional scanning.

Consider Cr USS if there is

  • Major collapse
  • Change in neurological status/seizures
  • Unexplained fall in haemoglobin
  • Abnormal head growth
  • Necrotising enterocolitis (NEC) - NB early and follow up at Cr USS at 4 weeks
  • Congenital infections
  • Congenital abnormality

Hypoxic Ischaemic Encephalopathy (HIE)
Routinely, babies receiving therapeutic hypothermia for HIE will need a cranial ultrasound.

  1. The request must state the date and time of the baby’s birth as well as the clinical indication for the USS
  2. The request must be for “Cr USS with Dopplers” not just Cr USS
  3. The examination will usually be performed between 48 and 72 hours of birth. Flexibility with timing should allow most examinations to be performed within routine hours.  Exceptionally an earlier scan will be requested by the Consultant Neonatologist.  If this is required out of hours the request must be made on a consultant to Consultant basis.  An early scan can help to time the insult.

Further information on Cr USS in HIE regarding the examination and reporting, can be found on the Cr USS protocol.

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Treatment / Management

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Provenance

Record: 4328
Objective:

Aims
To improve the use of investigation by Cr USS in the newborn infant

Objectives
To provide evidence-based recommendations for appropriate requesting and utilization of Cr USS in the newborn baby.

Clinical condition:

Cranial USS in the newborn infant

Target patient group: Newborns
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

  1. Imaging the premature infant brain: ultrasound or MRI Neuroradiology 2013 55 13-22

A. Meta-analyses, randomised controlled trials/systematic reviews of RCTs
B. Robust experimental or observational studies
C. Expert consensus.
D. Leeds consensus. (where no national guidance exists or there is wide disagreement with a level C recommendation or where national guidance documents contradict each other)

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Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

Related information

Not supplied

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