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Head ultrasounds for IVH/PVL screening in VLBW infants

Routine/screening head ultrasounds should be obtained on infants < 32 weeks gestation at 7 days of age to detect IVH.

Infants with a normal head ultrasound at 7 days of age do not need a repeat HUS until DOL #30 unless clinical concern develops.

Infants with a Grade I or II IVH without ventricular dilation need a follow-up HUS at DOL#30 or at the time of DC/BT, or sooner for an abnormally increasing OFC.

Infants with ventricular dilation need a F/U HUS weekly or as clinically indicated until ventricular size has stabilized.

A routine HUS is also obtained at 30 days of age on infants <32 weeks gestation. The 30-day HUS is designed to detect PVL and improve early detection of infants at risk for CP. Marlee Crankshaw is evaluating which infants have a high-yield 30-day HUS and in what population this exam is unnecessary and could be eliminated.

This information is also available in the 2001 NICU Manual pg. 8-1.

References:

http://www.neurology.org/cgi/content/full/58/12/1726

Boal DK, et al. Optimal cost-effective timing of cranial ultrasound screening in low-birth-weight infants. Pediatr Radiol 1995; 25 (6): 425-8.

Paul DA, et al. Cranial ultrasonography in very-low-birth-weight infants: do all infants need to be screened? Clin Pediatr 1999; 38 (9): 503-9.

Townsend SF, et al. Late neurosonographic screening is important to the diagnosis of periventricular leukomalacia and ventricular enlargement in preterm infants. Pediatr Radiol 1999; 29 (5): 347-52.