Cranial Ultrasound at 6 Weeks Postnatal Age Versus Term Equivalent Age in High-risk Pre-term Infants: A Prospective Cohort Study

Objective To determine whether cranial ultrasound (cUS) at term equivalent age (TEA) provides additional diagnostic information compared with routine imaging at 6 wk postnatal age (PNA) in high-risk pre-term infants. Methods A prospective cohort study at a tertiary neonatal intensive care unit in Melbourne, Australia, was carried out. Sixty-nine pre-term neonates born <32 wk gestation or <1500 g, with one or more clinical risk factors for brain injury, underwent cUS at both 6 wk PNA and TEA. Imaging findings were classified as normal or abnormal, and changes over time were categorised as stable, resolved or new. Results cUS brain abnormalities were identified in 70% of infants at 6 wk PNA and 90% at TEA ( p = 0.001), representing a significant increase in detection. Findings remained stable in 58% of cases; 38% had new abnormalities at TEA, including ventricular enlargement, widened interhemispheric fissures and parenchymal injury. Complete resolution was seen in only 4%. Conclusion Cranial ultrasound at TEA significantly improved the detection of potential brain injury compared with 6 wk PNA imaging. These findings support consideration of TEA as the preferred timing for final screening, potentially replacing the 6 wk PNA scan, although larger studies are needed to confirm optimal practice.