Prediction of cerebral palsy in very low birth weight preterm infants: a comparative study between cranial ultrasound and brain MRI

ABSTRACT

This prospective study was carried out in the neonatal intensive care unit, El-Minia university hospital. Two diagnostic modalities, serial cranial ultrasound [US] scans and brain magnetic resonance imaging [MRI] were performed once at near term on 38 very premature infants, "less than 32 weeks gestation" [20 males and 18 females] with very low birth weight [< 1500 g]. The aim was to compare both diagnostic modalities in identification of different brain injuries such as periventricular leucomalacia and intraventricular hemorrhage and to assess their value in early prediction of cerebral palsy [CP]. Infants were followed up by neurorehabilitation service up to 20 months corrected age, when all cases of CP can be diagnosed clinically. In the first group [8 patients with CP], MRI findings predicted CP cases with 87.3% sensitivity and positive predictive value of 70%. The corresponding figures for cranial US were 50% and 44.4% respectively. In the other group [30 infants without CP or with minor neurological abnormalities], MRI findings predicted neurologically normal infants [i.e. without CP] with 90% specificity and negative predictive value of 96.4%. The corresponding figures for cranial US being 83.3% and 86.2% respectively. It can be concluded that, though MRI is superior to cranial US for early prediction of CP; cranial US is still being used as a repeatable easy bed side diagnostic modality to demonstrate severe parenchymal lesions. MRI can be reserved for subtle lesions or cases with normal or controversial result by cranial US