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OBJECTIVE: To examine the association between neonatal cranial ultrasound (CUS) abnormalities among infants born extremely preterm and neurodevelopmental outcomes at 10 years of age. STUDY DESIGN: In a multicenter birth cohort of infants born at <28 weeks of gestation, 889 of 1198 survivors were evaluated for neurologic, cognitive, and behavioral outcomes at 10 years of age. Sonographic markers of white matter damage (WMD) included echolucencies in the brain parenchyma and moderate to severe ventricular enlargement. Neonatal CUS findings were classified as intraventricular hemorrhage (IVH) without WMD, IVH with WMD, WMD without IVH, and neither IVH nor WMD. RESULTS: WMD without IVH was associated with an increased risk of cognitive impairment (OR 3.5, 95% CI 1.7, 7.4), cerebral palsy (OR 14.3, 95% CI 6.5, 31.5), and epilepsy (OR 6.9; 95% CI 2.9, 16.8). Similar associations were found for WMD accompanied by IVH. Isolated IVH was not significantly associated these outcomes. CONCLUSIONS: Among children born extremely preterm, CUS abnormalities, particularly those indicative of WMD, are predictive of neurodevelopmental impairments at 10 years of age. The strongest associations were found with cerebral palsy.

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PURPOSE: Diffuse axonal injury (DAI) is the rupture of multiple axons due to acceleration and deceleration forces during a closed head injury. Most traumatic brain injuries (TBI) have some degree of DAI, especially severe TBI. Computed tomography (CT) remains the first imaging test performed in the acute phase of TBI, but has low sensitivity for detecting DAI, since DAI is a cellular lesion. The aim of this study is to search in the literature for CT signs, in the first 24 h after TBI, that may help to differentiate patients in groups with a better versus worst prognosis. METHODS: We searched for primary scientific articles in the PubMed database, in English, indexed since January 1st, 2000. RESULTS: Five articles were selected for review. In the DAI group, traffic accidents accounted 70% of the cases, 79% were male, and the mean age was 41 years. There was an association between DAI and intraventricular hemorrhage (IVH) and traumatic subarachnoid hemorrhage (tSAH); an association between the IVH grade and number of corpus callosum lesions; and an association between blood in the interpeduncular cisterns (IPC) and brainstem lesions. CONCLUSION: In closed TBI with no tSAH, severe DAI is unlikely. Similarly, in the absence of IVH, any DAI is unlikely. If there is IVH, patients generally are clinically worse; and the more ventricles affected, the worse the prognosis.

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Intracranial aneurysm rupture causes subarachnoid hemorrhage in 80% of the cases, and it may be associated with intracerebral hemorrhage and/or intraventricular hemorrhage (IVH) in 34% and 17% of the patients, respectively. However, on rare occasions, aneurysm rupturemay be present causing isolate intracerebral hemorrhage or IVH without subarachnoid hemorrhage. We describe an unusual case of an anterior communicating aneurysm rupture presented with IVH, without subarachnoid hemorrhage. Although isolated IVH is rare, aneurysm rupture is a possible condition. Patients presenting with head computed tomography revealing IVH without subarachnoid hemorrhage should be promptly investigated with contrasted image exam to identify and treat possible causes, even in the absence of subarachnoid hemorrhage.

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Introducción:la hemorragia intraventricular es una de las complicaciones más graves que se producen en el recién nacido prematuro.Objetivo: caracterizar desde el punto de vista materno-fetal y perinatal los recién nacidos pretérminos -sean o no de alto riesgo- a partir de la realización de la ecocardiografía transfontanelar como diagnóstico precoz de la hemorragia intraventricular. Método: se realizó un estudio observacional descriptivo transversal en el Hospital General Provincial Docente de Ciego de Ávila en el período septiembre/2015 a marzo/2017. El universo se conformó con los 218 niños recién nacidos pretérminos atendidos en el Servicio de Neonatología. Se cumplieron los preceptos éticos establecidos.Resultados: 8,30 porciento presentaron hallazgos ecográficos de hemorragia intraventricular, con predominio de nacidos con menor edad gestacional. De forma general, predominaron los nacidos con 2 000 g o más (61,93 por ciento); de ellos, 16,67 porciento presentaron hemorragia intraventricular. De estos últimos, 38,89 por ciento pesaron al nacer 1 000-1 499 g, cinco neonatos nacidos entre 27 y 29,6 semanas presentaron mayor gravedad, 64,68 porciento fueron producto de partos eutócicos, 27,06 por ciento fueron ventilados mecánicamente, 55,65 porciento tuvieron hipertensión pulmonar e hipercapnia, 44,44 por ciento membrana hialina, 27,78 porciento neumotórax y 33,3 por ciento no presentaron signos clínicos. Sin embargo 22,50 porciento de los neonatos sin hemorragia intraventricular fueron ventilados y 19,50 por ciento presentaron manifestaciones clínicas.Conclusiones: se evidenció la importancia de la ecografía transfontanelar para el diagnóstico precoz de la hemorragia intraventricular en neonatos pretérminos nacidos entre 32 y 36,6 semanas de gestación, no incluidos en el grupo de alto riesgo(AU)

Introduction:intraventricular hemorrhage is one of the most serious complications that occur in the premature newborn.Objective: to characterize from the maternal-fetal and perinatal point of view the preterm infants -whether or not they are high risk- from the transontanelar echocardiography as an early diagnosis of intraventricular hemorrhage. Method: a cross-sectional descriptive observational study was carried out at the General Provincial Teaching Hospital of Ciego de Ávila in the period September/2015 to March/2017. The universe was made up of the 218 preterm newborn children treated in the Neonatology Service. The established ethical precepts were fulfilled.Results: 8,30 percent presented ultrasound findings of intraventricular hemorrhage, with a predominance of infants with a lower gestational age. In general, those born with 2 000 g or more (61,93 percent) predominated; of them, 16,67 percent presented intraventricular hemorrhage. Of these, 38,89 percent weighed at birth 1 000-1 499 g, five infants born between 27 and 29,6 weeks were more serious, 64,68 percent were products of eutocic births, 27,06 percent were mechanically ventilated, 55,65 percent had pulmonary hypertension and hypercapnia, 44,44 percent hyaline membrane, 27,78 percent pneumothorax and 33,3 percent had no clinical signs. However, 22,50 percent of infants without intraventricular hemorrhage were ventilated and 19,50 percent presented clinical manifestations.Conclusions: the importance of transfontanelar ultrasound was evidenced for the early diagnosis of intraventricular hemorrhage in preterm infants born between 32 and 36,6 weeks of gestation, not included in the high-risk group(AU)

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OBJECTIVE: To identify risk factors for severe neurologic injury (intraventricular hemorrhage grade 3 or greater and/or periventricular leukomalacia) diagnosed by ultrasound scan of the head among infants born at 300-326 weeks of gestation and compare different screening strategies. STUDY DESIGN: This was a retrospective cohort study of infants born at 300-326 weeks or >326 weeks of gestation with a birth weight <1500 g admitted to neonatal intensive care units in the Canadian Neonatal Network from 2011 to 2016. Stepwise logistic regression analysis was used to identify significant risk factors and calculate aORs and 95% CIs. Risk factor-based screening strategies were compared. RESULTS: The rate of severe neurologic injury was 3.1% among infants screened (285/9221). Significant risk factors included singleton birth (aOR 1.96, 95% CI 1.35-2.85), 5-minute Apgar <7 (aOR 1.81, 95% CI 1.30-2.50), mechanical ventilation on day 1 (aOR 2.65, 95% CI 1.88-3.71), and treatment with vasopressors on day 1 (aOR 3.23, 95% CI 2.19-4.75). Risk categories were low (no risk factor, 1.2%, 25/2137), moderate (singleton with no other risk factor: 1.8%, 68/3678), and high (≥1 risk factor among 5-minute Apgar <7, receipt of vasopressors or mechanical ventilation on day 1: 5.6%, 192/3408). Screening moderate- to high-risk infants identified 91% (260/285) of infants with severe neurologic injury and would require screening fewer infants (1647 infants per year) than screening all infants <33 weeks of gestation (2064 infants screened per year, 93% [265/285] of cases identified). CONCLUSIONS: Risk factor-based ultrasound scan of the head screening among infants born at 30-32 weeks of gestation could help optimize resources better than gestational age based screening.

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