Purpose or Case Report: Extremely low gestational age (ELGA) infants are those born before 23 + 6 weeks of gestation. Continued advances on therapy and supportive care in the neonatal intensive units have allowed for an improved survival of these infants. Transfontanellar brain ultrasound (US) is the standard of care imaging modality to assess the integrity of the brain during the first weeks of postnatal life, as it provides a closer direct look to the brain. The purpose of this exhibit is to illustrate detailed US characteristics of the normal development and complications of the evolving premature brain of ELGA infants.
Methods & Materials: The sonographic characteristics and evolution of the brain developmental anatomy of 25 infants born between 22 + 0 weeks and 23 + 6 weeks of gestation were assessed, from baseline at birth and follow up with serial subsequent US exams. This educational exhibit will describe indications, advantages and limitations of the US technique and will provide a systematic approach to assess the normal development of brain structures, including a series of plots of interval growth of the developing brain.
Results: This investigation encompasses brain biometry, including a review of cortical development and appearance of sulci and major fissures, evolution of cortical rim, robust sonographic assessment of neuronal migration and basic organization of the cerebral hemisphere, white matter changes, size of corpus callosum, cerebellar and vermis diameters, hemispheric width, ventricular anterior horns and atrial width with ventricular frontal horn ratios and index, thalamo-occipital distance, evolution of Sylvian fissure, and evidence of anatomic variants, amongst others. Finally, we characterize the sonographic brain complications encountered in these infants.
Conclusions: This exhibit provides a systematic approach to review the premature brain in ELGA infants, assessing normal sonographic appearances and their evolution over time. It also provides reference values for intracranial anatomic landmarks. Familiarization of the normal sonographic appearances, during brain development, allows for prompt recognition of brain injury patterns in the extremely premature brain.