Cranial Sonography for Newborn Screening: A 10-year Retrospective Study in11,887 Newborns

Abstract

We retrospectively analyzed the results of a sonographic crania l screening study, performed between 1985 and 1994 to determine the incidence of intracrania l hemorrhage and cerebral anomalies based on obstetrical risk factors. I n the Department of Obstetrics and Gynecology of the University Giessen. Giessen , Germany, 94.6% (n = 11,887) of all children born during the study period 'Nere included and underwent sonographic cranial screening within the first 10 days after birth. Cerebra l abnormalities were found in 653 (= 5.5%) cases, and peri-/intravent ricular hemor­ rhages (PIVH. grade I-IV) in 303 cases. Periventricular leucomala­cia, porencephaly, subarachnoidal hemorrhage and hydrocephaly were rare (s 0.2 %). The Apgarindex proved to be a good prognostic factor. particularly at 1 and 5 minutes after birth (p < 0.0001). In contrast, correlation between PIVH and cardiotocography, arterial cord blood gases, and pH was poor. We did not observe a higher incidence of PIVH in newborns with growth retardation, pree­clampsia and premature ruptures of membranes or prolonged la­ bor. With decreasing gestational age. the frequ ency of PIVH i n­ creased progressively from 0.4 % at 39 weeks to 53.2% at 27 weeks (p < 0.001 ).We also found a higher risk of intracranial he­morrhage in preterm newborns with amniotic infections (38.1 %, p < 0.001 ). In mature babies, we did not find a difference between the incidence of PIVH and delivery-modes; however, we noted a higher risK of PIVH Grade IV in preterm newborns wit h breech presentation for vaginal delivery vers u s caesarean section (38.5% versus 7.4%, p = 0.005). The incidence of PIVH over this 10 year time period did not increase despite an increasing number of pre­ term newborns o•;er time. In conclusion. this study, which represents one of the largest patient cohorts studied for PIVH, indicates that neona tal sonographic cranial screening is an important tool to define quality control in obstetrics.