Purpose or Case Report: In this educational exhibit we will present a series of neonatal head ultrasound cases from our institution and present the correlative magnetic resonance imaging (MRI) which followed. We will describe a wide variety of pathologies that are often encountered but under-reported. We will also review imaging pitfalls encountered when interpreting neonatal head ultrasound and provide suggestions on how to improve the quality of these challenging examinations.
Methods & Materials: Neurosonography is widely used technique in the intra-cranial evaluation of the pre-term infant. The portability and lack of need to transport infants make this a favored modality for referring neonatologists. Furthermore, the imaging findings first encountered are used by neonatologists to help guide parents on patients’ need and future outcomes. Therefore, an accurate report is of the utmost importance. While most radiologist are familiar with interpretation of germinal matrix hemorrhage, many radiologists remain unfamiliar with the spectrum pathology that can be seen on neonatal head ultrasound and may be critical for patient management.

At our institution all preterm infants obtain neonatal head ultrasounds on the seventh day of life. Those with pathology will have follow up ultrasounds. All infants will then go to MRI upon reaching 36 weeks of corrected gestation age.
Results: In this presentation we plan to review, not only the presentation and grades of germinal matrix hemorrhage and their interpretation challenges, but also the following entities:

Periventricular Leukomalacia
Diffuse cerebral edema
Subdural hematoma
Acute ischemia
Aqueductal stenosis
Agenesis of the corpus callosum
Dandy-Walker Syndrome
Arnold-Chiari malformation
Vascular malformations
Dysplastic atrophic brain
Subarachnoid hemorrhage
Meningitis

We will provide imaging techniques and modifications in the protocols that may assist the pediatric radiologist in identifying pathology and interpreting neonatal head ultrasound in the infant prior to MRI.
Conclusions: Neonatal head ultrasound is an extremely valuable tool used in screening the preterm infant brain. However, interpretation of these images can be challenging and there are many pathologic abnormalities apart from germinal matrix hemorrhage that may be encountered. It is critical for the pediatric radiologist to be aware of these challenges in order to provide a clear and succinct report to the referring clinicians.