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

Preterm infants of greater gestational age should undergo a head ultrasound only if there are clinical concerns of IVH (unexplained anemia, severe apnea/bradycardia, abnormally increasing head circumference, etc.)

VLBW 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 head circumference.

Infants with ventricular dilation need a follow-up 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 cystic PVL and improve early detection of infants at risk for CP. 

The recently published practice parameter from the American Academy of Neurology also suggests that for infants < 30 weeks gestation at birth, a late screening head ultrasound should be performed at 36 – 40 weeks postconceptual age to detect PVL or ventriculomegaly.  This third screening head ultrasound may be particularly important for the ELBW (<1000g birthweight) population.  A late head ultrasound may be performed somewhat sooner for infants who are being discharged home or back-transported before 36 weeks postconceptual age.

Discussed at the Clinical Division Meeting 7/15/02.

References:

Ment LR, et al. Practice parameter: Neuroimaging of the neonate. Neurology 2002; 58: 1726-1738.  http://www.neurology.org/cgi/content/full/58/12/1726

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.