714 - Factors Associated with Abnormal Head Ultrasound in First Week of Life in Preterm Neonates

In 2020, the American Academy of Pediatrics (AAP) published a clinical report on routine neuroimaging in preterm infants recommending routine head ultrasounds (HUS) at 7-10 days, 4-6 weeks, and at term equivalent age or prior to discharge. The clinical report also recommends considering early HUS prior to 7 days of life (DOL) in infants at risk for severe cranial injury including severe intraventricular hemorrhage (IVH).

Objective:

The objectives of this study were to describe timing, indications, and abnormalities noted on HUS performed in preterm infants in the first 7 DOL and to identify potential risk factors associated with severe IVH.

Design/Methods:

This was a retrospective cohort study, including preterm infants born below 32 weeks and birth weight of 1500 grams in a level III neonatal intensive care unit between Jan 2016-Dec 2022. Infants who had HUS with in 7 DOL were analyzed, and HUS findings described.  Infant characteristics were compared between infants with and without severe IVH by bivariate analysis. Multinomial logistic regression was used to identify significant risk factors found significant on bivariate analysis. 2 tailed-p value < 0.05 was considered significant. 

Results: A total of 577 patients were screened, of which 213 (36.9%) had HUS before 7 DOL. Nearly half the early HUS were performed on day 2 or day 3 of age. The most common indication for early HUS were acute drop in Hb, followed by hemodynamic instability. 113 (52.6%) had abnormal HUS with IVH being most common abnormality (82%). Of the infants with IVH, severe IVH was noted in 29 infants (table 1). Bivariate analysis showed that infants with severe IVH were more preterm, lower birth weight, less exposed to prenatal steroids, with lower APGAR at 1 & 5 minutes, and more likely to have been transferred from outside hospital or resuscitated with normal saline bolus when compared to infants without severe IVH (p< 0.02, table 2). APGAR< 7 at 5 minutes, OR: 4 (1.7-9.6) and normal saline bolus during resuscitation after birth, OR: 15 (2.9-84) were associated with severe IVH on multinomial logistic regression (table 3).

Conclusion(s):

Early HUS before 7 days were performed in nearly one third of preterm infants included in the study with IVH being the most common abnormality detected. We report risk factors associated with severe IVH, namely APGAR scores below 7 at 5 minutes and resuscitation requiring normal saline after birth, that may guide clinicians in considering early HUS within the first 7 days of life.