Cranial Ultrasound Findings in Premature Neonates Admitted in Tertiary Care Hospital

Abstract

Background: Preterm neonates are vulnerable to hemorrhagic and ischemic brain injury, which contributes substantially to mortality and long-term neurodevelopmental impairment. Cranial ultrasound is the most accessible bedside neuroimaging tool for early detection of intraventricular hemorrhage and cystic white matter injury in neonatal intensive care settings. Objective: To determine cranial ultrasound findings among premature neonates admitted to a tertiary care neonatal unit and evaluate associations with gestational age, birth weight, maternal risk factors, neonatal comorbidities, and mortality. Methods: This cross-sectional observational study was conducted in the Department of Pediatrics, Bolan Medical College, Quetta, from 2 December 2023 to 3 June 2024. Premature neonates admitted to the NICU were enrolled after informed consent. Cranial ultrasound was performed by an experienced radiologist, and findings were categorized as normal or abnormal. Associations with gestational age, birth weight, maternal factors, neonatal comorbidities, and outcomes were analyzed using chi-square/Fisher’s exact tests, with statistical significance set at p≤0.05. Results: Among 152 premature neonates, 97 (63.8%) had abnormal cranial ultrasound findings. Intraventricular hemorrhage was the most frequent abnormality (40.42%), followed by periventricular hyper-echogenicity (21.27%). Abnormal ultrasound was significantly associated with lower gestational age and low birth weight, and with respiratory distress syndrome (p=0.014) and birth asphyxia (p=0.008). Mortality was 36.1% and occurred exclusively in the abnormal ultrasound group, with intraventricular hemorrhage reported as the leading imaging-associated correlate of death. Conclusion: Abnormal cranial ultrasound findings were common and clinically meaningful, with intraventricular hemorrhage predominating and carrying the highest mortality risk, supporting risk-stratified neurosonographic screening in premature neonates.