Screening head ultrasound to detect intraventricular hemorrhage in premature infants

Objective. The objective of this case-control study was to develop a screening protocol using head ultrasound (HUS) to detect high-grade intraventricular hemorrhage (IVH) in very-low-birthweight infants with greater specificity than current practice, while maintaining a high degree of sensitivity. Materials and methods. All infants less than or equal to 32 weeks or less than or equal to 1500 g admitted to the neonatal intensive care unit between January 1, 1991 and December 31, 1992 were studied. The 1991 cohort was analyzed to identify the factors most sensitive and specific for predicting the occurrence of a high-grade (III or IV) IVH. Results. Eighty-five percent of infants born at 28-32 weeks gestation screened by 2 weeks of age for IVH had normal HUS scans. The factors most predictive of a high-grade IVH were gestational age < 28 weeks, forceps delivery, or any of the following in the first 2 weeks of life: seizures, head circumference increasing by more than 1 cm per week, base deficit greater than or equal to 10, or cardiopulmonary resuscitation in the neonatal intensive care unit. Conclusion. Infants born at 28-32 weeks with a high-grade IVH can be identified with a high degree of sensitivity using refined screening criteria, eliminating 50% of the HUS scans currently obtained for IVH screening.