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Cranial Ultrasound Lesions in the NICU Predict Cerebral Palsy at Age 2 Years in Children Born at Extremely Low Gestational Age

Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston University, Boston, Massachusetts, karl.kuban@bmc.org

Elizabeth N. Allred, MS

Neuroepidemiology Unit, Department of Neurology, Children's Hospital Boston, Harvard University, Boston, Massachusetts, Department of Biostatistics, Harvard School of Public Health, Harvard University, Boston, Massachusetts

T. Michael O'Shea, MD, MPH

Department of Neonatology, Wake Forest University, Winston-Salem, North Carolina

Nigel Paneth, MD, MPH

Departments of Epidemiology and Pediatrics & Human Development, College of Human Medicine, Michigan State University, East Lansing, Michigan

Marcello Pagano, PhD

Neuroepidemiology Unit, Department of Neurology, Children's Hospital Boston, Harvard University, Boston, Massachusetts, Department of Biostatistics, Harvard School of Public Health, Harvard University, Boston, Massachusetts

Olaf Dammann, MD

Neuroepidemiology Unit, Department of Neurology, Children's Hospital Boston, Harvard University, Boston, Massachusetts, Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts

Alan Leviton, MD

Neuroepidemiology Unit, Department of Neurology, Children's Hospital Boston, Harvard University, Boston, Massachusetts

Adré Du Plessis, MBChB, MPH

Department of Neurology, Children's Hospital Boston, Harvard University, Boston, Massachusetts, Brigham and Women's Medical Center, Boston, Massachusetts

Sjirk J. Westra, MD

Massachusetts General Hospital, Boston, Massachusetts, Harvard Medical School, Harvard University, Boston, Massachusetts

Cindy R. Miller, MD

Yale University School of Medicine, New Haven, Connecticut

Haim Bassan, MD

Department of Neurology, Children's Hospital Boston, Harvard University, Boston, Massachusetts

Kalpathy Krishnamoorthy, MD

Massachusetts General Hospital, Boston, Massachusetts

Joseph Junewick, MD

DeVos Children's Hospital, Grand Rapids, Michigan

Nicholas Olomu, MB, BS

Departments of Epidemiology and Pediatrics & Human Development, College of Human Medicine, Michigan State University, East Lansing, Michigan

Elaine Romano, MSN

Yale University School of Medicine, New Haven, Connecticut

Joanna Seibert, MD

Arkansas Children's Hospital and University of Arkansas Medical Science, Little Rock, Arkansas

Steve Engelke, MD

East Carolina University, Greenville, North Carolina

Padmani Karna, MBBS

Departments of Epidemiology and Pediatrics & Human Development, College of Human Medicine, Michigan State University, East Lansing, Michigan

Daniel Batton, MD

William Beaumont Hospital, Royal Oak, Michigan

Sunila E. O'Connor

Department of Neurology, Section of Pediatric Neurology at the Medical College of Wisconsin, Milwaukee, Wisconsin

Cecelia E. Keller, PT, MHA for the ELGAN study investigators

Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts

Our prospective cohort study of extremely low gestational age newborns evaluated the association of neonatal head ultrasound abnormalities with cerebral palsy at age 2 years. Cranial ultrasounds in 1053 infants were read with respect to intraventricular hemorrhage, ventriculomegaly, and echolucency, by multiple sonologists. Standardized neurological examinations classified cerebral palsy, and functional impairment was assessed. Forty-four percent with ventriculomegaly and 52% with echolucency developed cerebral palsy. Compared with no ultrasound abnormalities, children with echolucency were 24 times more likely to have quadriparesis and 29 times more likely to have hemiparesis. Children with ventriculomegaly were 17 times more likely to have quadriparesis or hemiparesis. Forty-three percent of children with cerebral palsy had normal head ultrasound. Focal white matter damage (echolucency) and diffuse damage (late ventriculomegaly) are associated with a high probability of cerebral palsy, especially quadriparesis. Nearly half the cerebral palsy identified at 2 years is not preceded by a neonatal brain ultrasound abnormality.

Key Words: cerebral palsy • extremely low gestational age • cranial ultrasound

Journal of Child Neurology, Vol. 24, No. 1, 63-72 (2009)
DOI: 10.1177/0883073808321048


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