Postnatal Brain Growth Assessed by Sequential Cranial Ultrasonography in Infants Born &lt;30 Weeks' Gestational Age

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Fig 1.
Cranial ultrasonography linear measures: images through the anterior fontanel in the coronal plane at the level of foramina of Monro (A) and the sagittal (C) and parasagittal (D) planes, and an image through the mastoid fontanel in the coronal plane posterior to the fourth ventricle (B). Brain tissue: biparietal diameter (a), corpus callosum length (b), corpus callosum genu width (c), corpus callosum body height (d), corpus callosum splenium width (e), transcerebellar diameter (f), and vermis height (g). Fluid spaces: interhemispheric distance (h), ventricular width (i), ventricular index (j), anterior horn width (k), anterior horn height (l), ventricular midbody width (m), and thalamo-occipital distance (n).
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Fig 2.
Cranial ultrasonography linear measures with respect to postnatal age. A, Brain tissue. B, Fluid spaces.

Table 1:

Infant characteristics

Perinatal Variable	Summary (N = 144 Infants)
Gestational age (mean) (SD) (wk)	27.7 (1.5)
Birth weight (mean) (SD) (g)	1017 (259)
Small for gestational age, birth weight <−2 SDs (No.) (%)	16 (11)
Female (No.) (%)	75 (52)
Multiple gestations (No.) (%)	64 (44)
Cesarean delivery (No.) (%)	106 (74)
Antenatal corticosteroids (No.) (%)	134 (93)
Antenatal magnesium sulfate (No.) (%)	103 (72)
Respiratory distress from birth (No.) (%)	141 (98)
Surfactant (No.) (%)	91 (63)
Duration of positive pressure ventilation (median) (25th–75th centile) (days)	19 (0–96)
Duration of supplemental oxygen (median) (25th–75th centile) (days)	19 (4–56)
Bronchopulmonary dysplasia^{^a} (No.) (%)	46 (32)
Postnatal corticosteroids (No.) (%)	18 (13)
Intraventricular hemorrhage, grades I or II (No.) (%)	25 (17)
Retinopathy of prematurity (No.) (%)	32 (22)
Sepsis confirmed^{^b} (No.) (%)	20 (14)
NEC (No.) (%)	17 (12)
Sepsis confirmed and/or NEC (No.) (%)	31 (22)
Survived to discharge home (No.) (%)	139 (97)

Table 2:

Reproducibility of cranial ultrasonography linear measures

Linear Measure	Intraobserver		Interobserver
Linear Measure	ICC	95% CI	ICC	95% CI
Brain tissue
Biparietal diameter	0.98	0.95–0.99	0.97	0.94–0.99
Corpus callosum length	0.99	0.97–0.99	0.98	0.95–0.99
Corpus callosum genu width	0.78	0.53–0.90	0.38	−0.04–0.69
Corpus callosum body height	0.74	0.52–0.87	0.58	0.27–0.78
Corpus callosum splenium width	0.80	0.56–0.92	0.21	−0.22–0.58
Transcerebellar diameter	0.99	0.98–0.99	0.98	0.96–0.99
Vermis height	0.91	0.82–0.96	0.81	0.62–0.91
Fluid spaces
Interhemispheric distance	0.98	0.96–0.99	0.98	0.95–0.99
Anterior horn width, left	0.94	0.87–0.97	0.91	0.81–0.96
Anterior horn width, right	0.96	0.90–0.98	0.95	0.89–0.98
Ventricular index, left	0.85	0.70–0.93	0.85	0.69–0.93
Ventricular index, right	0.63	0.32–0.82	0.59	0.26–0.80
Ventricular width	0.87	0.72–0.94	0.89	0.76–0.95
Anterior horn height, left	0.86	0.72–0.94	0.76	0.53–0.88
Anterior horn height, right	0.92	0.82–0.96	0.78	0.55–0.90
Ventricular midbody height, left	0.73	0.49–0.87	0.47	0.11–0.72
Ventricular midbody height, right	0.81	0.61–0.91	0.52	0.18–0.75
Thalamo-occipital distance, left	0.93	0.81–0.97	0.80	0.52–0.93
Thalamo-occipital distance, right	0.92	0.80–0.97	0.62	0.22–0.84

Table 3:

Associations between perinatal variables and postnatal brain growth

Perinatal Variable	Adjusted^{^a} Growth (mm/week PNA)		Interaction Term^{^b} (P Value)
Perinatal Variable	β	95% CI	Interaction Term^{^b} (P Value)
Biparietal diameter
GA
<28 weeks	1.88	1.71–2.05	.002
≥28 weeks	1.29	0.96–1.62	.002
Corpus callosum length
BW z score
≥−2 SD	0.91	0.84–0.98	.045
<−2 SD	0.73	0.57–0.89	.045
Postnatal corticosteroids
No	0.92	0.85–1.00	.046
Yes	0.77	0.63–0.90	.046
Bronchopulmonary dysplasia
No	0.98	0.88–1.07	.01
Yes	0.81	0.73–0.89	.01
Transcerebellar diameter
Antenatal corticosteroids
No	2.26	1.81–2.70	.023
Yes	1.73	1.63–1.83	.023
Postnatal corticosteroids
No	1.84	1.74–1.95	<.001
Yes	1.41	1.22–1.61	<.001
Bronchopulmonary dysplasia
No	1.89	1.75–2.02	.008
Yes	1.63	1.49–1.76	.008
Sepsis/NEC
No	1.82	1.71–1.93	.016
Yes	1.55	1.36–1.74	.016
Vermis height
Postnatal corticosteroids
No	0.63	0.58–0.69	.011
Yes	0.49	0.39–0.59	.011
Ventricular width
GA
<28 weeks	0.64	0.57–0.71	.004
≥28 weeks	0.41	0.27–0.55	.004