Purpose or Case Report: Extremely low gestational age (ELGA) infants are those born before 23 + 6 weeks of gestation. These infants are prone to multiple complications. Frequent complications affect the brain. Transfontanellar brain ultrasound (US) is the standard of care imaging modality to assess the brain during the first weeks of life. An appropriate ultrasound technique includes assessment of the brain in gray scale, color and spectral Doppler. Doppler US should be interpreted in correlation with the neonate’s clinical and systemic hemodynamic state, postnatal age, blood gas concentrations, respiratory or cardiovascular complications, amongst others. Prior literature focuses on the sonographic characteristics of premature, near term and term infants. However, Doppler US characterization of the intracranial vessels of ELGA infants is lacking. The purpose of this exhibit is to describe the resistive index (RI) and peak systolic velocities (PSV) of the anterior cerebral artery and the PSV of the superior sagittal sinus of a cohort of ELGA infants, and to assess their correlation with complications encountered in these infants.
Methods & Materials: In this exhibit, we included the sonographic patterns and evolution of the main intracranial vascularity of 25 ELGA infants born between 22 + 0 weeks and 23 + 6 weeks of gestation, from baseline at birth and a follow up of 90 serial US exams. This educational exhibit is organized as follows: 1) a short description, advantages and limitations of the Doppler US technique; 2) a systematic approach to assess the intracranial vessels with focus on the anterior cerebral artery and superior sagittal sinus; 3) provide a series of plots of the evolution of the Spectral Doppler changes in these vessels overtime; 4) A series of illustrative cases of normal and abnormal sonographic appearances of the vessels in ELGA infants and their correlation with hemodynamic alterations or complications.
Results:
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