Neurosonogram and Common Doubts

A neurosonogram, also known as a cranial ultrasound, is an imaging test that uses sound waves to visualize a newborn baby’s brain. Since the bones of the skull are not fully formed at birth, the soft spot (fontanelle) on the top of the baby’s head serves as a natural window for ultrasound to assess the brain. Additional windows, such as the posterior and mastoid fontanelles, may also be used for better evaluation.

Neurosonography is most reliable in babies under six months old, as the fontanelle gradually closes over time. This test is portable and can be performed bedside in neonatal intensive care units (NICUs) or in the radiology department. However, it has limitations—some deeper or peripheral areas of the brain may not be fully visualized.

Is it Safe?

Yes, cranial ultrasound is very safe. Unlike CT scans or X-rays, it does not use ionizing radiation, making it a preferred radiation-free imaging modality for newborns. Radiologists take care to minimize scan duration while ensuring a thorough evaluation.

When is it Done?

A neurosonogram is a valuable tool for detecting various intracranial conditions, including:

● Congenital anomalies ● Intracranial hemorrhage (bleeding) ● Hypoxic-ischemic injury (lack of oxygen and blood supply to the brain) ● Hydrocephalus (fluid buildup in the brain) ● Vein of Galen malformation

● Brain infections

With advancements in neonatal care, preterm babies can now be managed effectively in NICUs until they are stable enough for discharge. However, due to their increased risk of brain-related complications, routine neurosonogram are often performed, especially in preterm infants.

Routine Neurosonogram Schedule for Preterm Infants:

Depending on hospital protocols, premature babies may undergo serial neurosonograms at specific intervals, such as:

● Day 0 (at birth) ● Day 7 ● Day 14

● Day 28

In some cases, follow-up neurosonograms may be required even after discharge to monitor for late-developing changes in the brain.

Common Doubts Regarding Neurosonogram Reports

1. What does "Periventricular Flare" mean?

"Periventricular flare," also called periventricular echogenicity (PVE), appears as a brighter-than-usual area near the fluid-filled spaces (ventricles) of the brain. This region is particularly vulnerable to ischemic (low oxygen) injury due to its delicate blood supply in preterm infants.

However, PVE can have multiple causes:

● It may be a normal variant ● It can be transient, related to mild water content in a premature brain ● It can be due to infection (sepsis)

● In a few cases, it may progress to periventricular leukomalacia (PVL), a form of brain injury - which is best understood clinically.

Since ultrasound findings should never be interpreted in isolation, a discussion with your pediatrician or neonatologist is essential to understand the clinical significance.

2. What is a "Germinal Matrix Hemorrhage" (GMH)?

A germinal matrix hemorrhage (GMH) is a bleed in a specific region of the brain called the caudothalamic groove, which contains fragile blood vessels. This is one of the most common sites of bleeding in preterm infants due to their immature vascular system.

Grading of GMH:

● Grade 1 GMH means the bleeding is limited to the caudothalamic groove.

● Grade 1 hemorrhages are common and often resolve on their own.

While mild hemorrhages are generally not worrisome, follow-up ultrasounds are recommended to monitor their progression. Your pediatrician will guide you on the next steps based on your baby’s condition.

What Should You Do?

● A clear discussion with your neonatologist or pediatrician is crucial in interpreting neurosonogram findings. ● Many terms in the report may sound alarming, but not all findings indicate serious conditions.

● Follow-up scans may be needed for better assessment over time.

Limitations of Neurosonogram

● Some areas of the brain may not be well visualized due to the limited ultrasound penetration through bone. ● In complex cases, additional imaging—such as MRI—may be required for a more detailed evaluation.

● Interpretation should always be done in conjunction with clinical findings.

Final Thoughts

A neurosonogram is a safe, effective, and widely used tool for evaluating newborn brain health. However, understanding the context of the findings is key. Your healthcare team is the best resource for discussing the results and any necessary next steps.

References

1. Bellar, T., Peylan, T., Ben-Sira. Quantitative analysis of cranial ultrasonographic periventricular echogenicity in relation to early neuromotor development in preterm infants.