It is used in various fields of medicine. Pediatrics is no exception. Newborns are prescribed neurosonography to detect brain pathologies. This research method has a lot of advantages - high information content, no radiation exposure, non-invasiveness, the possibility of multiple examinations.
Neurosonography: what is it
NSG is an ultrasound technique for studying the brain of an infant or newborn child. At the moment, it is considered an important component of the traditional. Neurosonography allows doctors to detect various pathologies:
- congenital defects;
- violation of the structure of the body in infectious and inflammatory diseases;
- hemorrhages;
- ischemic lesions.
Portable scanners can be used for this. In their absence, a stationary device is used. In such cases, children are examined in the ultrasound room (before scanning, a special sanitization of the room and the scanner is carried out).
Indications for NSG
Neurosonography in newborns is performed in maternity hospitals. The study is appointed in the presence of the following indications:
- Prematurity. This term is used to refer to the state of the fetus, which was born before the end of the normal period of intrauterine development. A born baby is considered premature if the gestational age (the period lasting from the first day of the last menstruation to delivery) is less than 36 weeks.
- Low results of the assessment of the condition of the newborn. It is carried out on the Apgar scale at 1-5 minutes of life. Within the normal range, this indicator should be equal to 7 points. NSG is carried out in cases where the child, 5 minutes after birth, receives less than 7 points.
- Small body weight. In newborns, this figure can range from 3 to 3.5 kg within the normal range. Small deviations are allowed. Body weight not exceeding 2800 g indicates the possible presence of serious pathologies. With this value of the indicator, the NSG is carried out.
An indication for the study is also the presence in the anamnesis of chronic intrauterine hypoxia, infectious diseases in the newborn child and his mother, asphyxia that occurred during childbirth. Neurosonography is also necessary in the presence of clinical signs of disruption of the central nervous system (constant shuddering, tremor of the limbs and chin, decreased motor activity), multiple stigmas of disembryogenesis (small deviations in the anatomical structure of any organs).
Neurosonography of the brain
After discharge from the maternity hospital, NSG is prescribed for children in the 1st month of life. The study is carried out in a children's clinic. After the 1st month of life, neurosonography in children is performed according to the same indications as in newborns (prematurity, low birth weight, signs of CNS damage and multiple dysembryogenesis stigmas). Repeated examinations are prescribed if there are indications and to evaluate the effectiveness of treatment.
Preparation for the examination
In some cases, special preparation is required. This does not apply to neurosonography. Anesthesia or special medical preparation before NSG is not required. The only recommendation to parents is to feed the child before the examination (a well-fed baby will sleep).
There are no contraindications to the examination. Neurosonography can be performed even in those babies whose general condition is assessed as severe. If the child is in the intensive care unit or intensive care unit, then the scan is done in an incubator (a special device in which a sick or premature baby is placed).
The study is performed using a vector or standard convex probe. Its frequency is about 6 MHz (when performing an organ scan in newborns) or about 2 MHz (when performing neurosonography in older babies).
Specialists fix the sensor in the area of the large fontanelle and make several scans. If the transducer is placed along the coronal suture, then sections are obtained in the frontal plane, also called the coronal plane. It studies the brain. Its structures are sequentially examined, starting from the frontal and ending with the occipital lobes.
When the probe is rotated 90 degrees, sections are obtained in the parasagittal and sagittal planes. In the first scans, the periventricular regions and subcortical nuclei are evaluated, measurements of fragments of the lateral ventricles are taken, and the choroid plexuses are visualized. In the sagittal scan, the patency of the CSF pathways is determined. After the examination, the results are decoded.
An axial plane can be used (examination is through the temporal bone). However, such a scan is extremely rare. Neurosonography of newborns through this plane is sometimes prescribed after the closure of the fontanel (at the age of 9-12 months and older).
NSG results in normal and pathological conditions
The image obtained as a result of neurosonography shows the anatomical structures of the organ. All bone formations are hyperechoic. The parenchyma of the organ has an average echogenicity. In the coronal plane is visible. On the echogram, it looks like a hyperechoic linear structure with small grooves. Their number and severity depends on the gestational age.
At any gestational age in children during neurosonography, the corpus callosum is detected - a plexus of nerve fibers that connects the left and right hemispheres. When scanning, an assessment of such indicators as size, clarity of structure is carried out. Norms of the corpus callosum: length is about 35-50 mm, thickness in the trunk area is 3-5 mm.
The brain contains cavities filled with cerebrospinal fluid. They are called stomachs. On the echogram, they are identified in the form. During NSG, the cisterns of the brain (spaces between the meninges) are also evaluated. An important role is played by the condition of the large tank. Its structure often reflects anomalies in the development of the posterior cranial fossa.
An important part of the brain is the cerebellum. Its function is to coordinate movements, regulate balance, and muscle tone. The cerebellum includes the right and left hemispheres. They are connected by a "worm" - an unpaired structure. On the echogram of the cerebellar hemisphere in the 1st month of life, they look like hypoechoic structures, the location of which is the posterior cranial fossa. "Worm" is hyperechoic.
2. Sonographic picture in premature babies
The structure of the organ in a child depends on the gestational age. In very premature babies, a wide subarachnoid space is visualized on echograms. It becomes smaller as the parietal and frontal lobes of the brain mature.
Around the lateral ventricles, a "physiological halo" with increased echogenicity may be detected. It is seen in premature babies. The echogenicity of the halo is sometimes comparable to the echogenicity of the choroid plexus (or exceeds it). In such cases, specialists suspect an ischemic lesion. Perhaps the development of periventricular pseudocysts.
Neurosonogram of a premature newborn with cystic formation
A feature of the echogram made with neurosonography in premature babies is the presence of the Verge cavity and the cavity of the transparent septum. They are defined in the 1st month of life as . The Verge cavity begins to close after 24-25 weeks of pregnancy. The cavity of the transparent septum becomes smaller as the child grows older. After 3 months, it ceases to be visualized in most children.
Pathologies of the brain
The appearance of pathological changes in the body is often due to diseases of an infectious and inflammatory nature. Specialists distinguish between intrauterine infections (for example, herpes, toxoplasmosis, cytomegalovirus) and neuroinfections of the postnatal period (bacterial, viral meningitis).
There are no specific ultrasound signs that distinguish infectious processes. Infectious-inflammatory diseases cause similar morphological disorders.
The decoding of the echogram is carried out according to the following features:
- necrosis of the parenchyma of the brain;
- inflammatory infiltration of the meningeal membrane;
- the appearance of calcifications, porencephalic and subependymal cysts;
- expansion of the ventricles, subarachnoid space.
Neurosonography allows you to detect abnormalities in the development of the brain in a newborn:
- congenital hydrocephalus. The decoding of this term means an excessive accumulation of cerebrospinal fluid in the cranial cavity. If, during the NSG, dilated ventricles of the brain are detected, this means that the child has an obstructive form of hydrocephalus. The communicating variety of pathology is characterized by the expansion of not only the ventricles, but also the subarachnoid space, the cisterns of the brain.
- Holoprosencephaly. The interpretation of this diagnosis is the non-division of the forebrain into hemispheres. There are 3 forms of holoprosencephaly. With the alobar variety, the brain looks like a single cavity. The seven-bar form is characterized by the presence of a rudiment that replaces the occipital lobes. Neurosonography visualizes one ventricle. There are no olfactory bulbs or corpus callosum. With the lobar form, which is considered the mildest, partial agenesis of the corpus callosum is possible.
- Porencephaly. With this defect in the middle parts of the cerebral hemispheres there are cavities (true cysts). They communicate with the ventricles and the subarachnoid space. During the examination, these cysts are found in the form of rounded formations with a clear wall.
During NSG, tumors are sometimes detected. They are mainly located in the midline (in the third ventricle, in the cerebellum, in the pineal gland). Due to neoplasms, asymmetry of the ventricles of the brain is observed, calcifications, hemorrhages, and cystic lesions occur. It is by these consequences that it is possible to diagnose tumors during NSG in the 1st month of life. However, it is impossible to determine their type using this research method.
A significant place among all pathologies is occupied by hemorrhagic changes. One such brain injury is subarachnoid hemorrhage. Most often it is observed in premature babies due to a lack of oxygen. Subarachnoid hemorrhage is characterized by the following echographic picture:
- increased echogenicity of the pattern of furrows and convolutions on the convexital surface of the brain;
- presence with fuzzy contours (blood).
In conclusion, it should be noted that neurosonography is a highly informative diagnostic method. Thanks to NSG in a newborn or infant, brain pathologies can be detected or the effectiveness of the treatment can be assessed. The examination is absolutely safe for the baby. It can be done multiple times. Painful sensations in the baby during the NSG does not occur.
Neurosonography is a mandatory measure for examining a newborn child, which involves scanning the brain with ultrasound.
Such an ultrasound is often prescribed, because pregnancy, childbirth and the first months of a baby's life are not immune from problems.
Neurosonography is done to a newly born child if they find:
- convex or sunken fontanel;
- pulsation in the fontanel;
- infection of the fetus in the womb (including infection from the mother);
- the absence of the first breath of the child.
Identified during pregnancy, violations of fetal development, such as chromosomal pathologies, can also be the reason for a brain examination.
If the mother of the child, being pregnant, took drugs or alcohol, she will also have to give the baby for neurosonography.
Neurosonography of newborns is mandatory if the baby was born before the due date (before the 37th week).
The passage of neurosonography may be required when the mother and the newborn have a different Rh factor. It is important to examine the brain of a newborn even when hypoxia is suspected.
The reason for neurosonography may be difficult or pathological childbirth. It is also necessary if the condition of the newborn on the Apgar scale was assessed by doctors as low.
The child will be asked to be brought in for neurosonography after a month if seizures, epilepsy, or problems with the nervous system occur.
Other reasons for the need for an ultrasound examination of the child's brain may be:
- violation of proportions or non-standard head size;
- delay in growth and development;
- suspicion of strabismus;
- hemorrhage inside the eyeball.
Neurosonography of newborns is often done as an additional procedure after obtaining an encephalogram.
An ultrasound of the brain in this case is necessary to clarify whether the newborn has an injury due to a fall or diagnoses such as cerebral palsy, encephalitis, rickets, ischemia, meningitis, an autoimmune disease, or Aper's syndrome.
The need for neurosonography may also arise when the newborn has increased intracranial pressure or there is a suspicion of an oncological disease.
Neurosonography is also needed if the child is hyperactive and has genetic abnormalities in development.
Blood poisoning, complications after viral diseases and problems with organs are also indications for neurosonography.
Conditions for neurosonography
There is no need to prepare a newborn for an ultrasound head examination procedure. It does not matter whether the child is fed immediately before neurosonography or not.
But still, it is better to carry the baby to this study after feeding. A well-fed child will be calm and will not interfere with the doctor's examination of the head.
Neurosonography is performed for infants in the first week of their life and for children after a month. Restrictions in the appointment of this procedure relate specifically to the age of the baby.
The fact is that neurosonography can be done only at a time when the child has not overgrown the fontanel, located between the two zones of the skull - the frontal and parietal. This usually happens after the 9th month.
Neurosonography can also be done through some other fontanel. But most often other non-ossified areas of the cranial vault are very small.
It is difficult to examine the brain through a tiny fontanel. In addition, all fontanelles, except for the fronto-parietal, have time to close even before the baby is born.
When the child was born prematurely or he is in serious condition, the study is carried out in intensive care.
The newborn needs to be in a supine position and make a minimum of movements of the order of ten minutes. It is not necessary to administer the drug for anesthesia to the child, since the procedure is absolutely painless.
During neurosonography, the mother will be asked to hold the baby's head so that he does not turn it to the sides.
Before the study, the fontanel on the head is lubricated with a special gel that does not cause allergic reactions.
This ointment facilitates inspection and eliminates possible interference (due to sliding of the device over adjacent tissues).
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For some time, the doctor drives along the fontanel with a sensor, changing its angle and location. As a result, the specialist receives an image of the cerebral cortex on the monitor screen.
After neurosonography, the mother of the newborn is given a conclusion. With it it is necessary to address to the neuropathologist.
What results indicate the norm?
Deciphering the conclusion from the neurosonography procedure is based on certain indicators and parameters.
The sonologist writes in the protocol what shape the brain tissues have - symmetrical and asymmetric. If the structure of the brain tissue does not deviate from the norm, then absolute symmetry is observed.
The fact that the norms are not violated is evidenced by a clear visualization on the screen of the convolutions and furrows of the brain.
If there are no violations, the examination protocol should indicate that the ventricles of the brain do not have inclusions, that they are the same and homogeneous.
Deciphering the word "flakes" in the description of the ventricles may mean that a hemorrhage has occurred in this area.
The correct shape of the cerebellum tenon is necessarily trapezoid and symmetrical. The indentation of the dura mater should be located above the posterior cranial fossa in the occipital region.
The gap between the two hemispheres in the normal state of the brain is devoid of fluid. Plexus vessels without violations have a homogeneous structure.
The norms for various indicators determined by neurosonography include the following numerical values:
- up to 2 mm - the depth of the anterior horn of the lateral ventricle;
- about 2 mm - the depth of the gap between the left and right hemispheres;
- up to 6 mm - the size of the third ventricle;
- up to 6 mm - the width of the subarachnoid space.
Neurosonography at 3 months involves the determination of the same parameters and almost the same norms.
At this age, the child is mostly examined cisterns, ventricles of the brain and subarachnoid space.
A positive interpretation of neurosonography results will include the following numbers:
- not less than 2 and not more than 4 mm - the size of the body of the lateral ventricle;
- no more than 2 mm - the depth of the anterior horn of the lateral ventricle;
- from one and a half to three mm - the size of the subarachnoid space;
- no more than five mm - the size of a large tank.
Normative indicators of neurosonography for children under three months are reflected in the table:
| Indicators | The norm for the baby | Norm for a child in 1 - 3 months |
| Ventricles of the brain (lateral) | Anterior horns - 1.5 mm (+/- 0.5 mm); occipital horns - 1 - 1.5 cm; body - up to 4 mm. | Anterior horns - up to 2 mm; occipital horns - up to 1.5 cm; body - 3 mm (+/- 1 mm). |
| third ventricle | 4.5mm (+/-0.5mm) | Max 5mm |
| The gap between the hemispheres | Max 2mm | Max 2mm |
| big cistern | Max 6mm | 3 - 5 mm |
| subarachnoid space | 2-3 mm | Max 2mm |
Pathologies in neurosonography
As a result of a baby's fall, intrauterine development disorders, or other serious problems, neurosonography can reveal a number of diseases. These include a choroid plexus cyst.
This disease is characterized by an asymptomatic course. It is the formation of tiny bubbles that dissolve without medical intervention.
Deciphering neurosonography by a specialist may contain information about the presence of a subependymal cyst.
This formation is a consequence of cerebral hemorrhage, which may appear in the womb or after childbirth. Such a cyst must be treated because it can grow.
Sometimes a cyst can be found on the arachnoid. In this case, it is called arachnoid.
This formation contains fluid and is able to increase in size. Therefore, this disease must be controlled by constantly visiting a neurologist.
Neurosonography can diagnose dropsy of the brain in a newborn, which is an expansion of the ventricles due to the accumulation of fluid in them. Hydrocephalus is subject to mandatory treatment.
Due to the fall, the baby may develop hematomas of the brain tissue. This is a dangerous pathology that requires immediate treatment and constant monitoring of the recovery process. Often this pathology occurs in premature babies.
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Equally dangerous is ischemic brain damage and hypertension syndrome.
The latter disease is a consequence of high intracranial pressure. It may be accompanied by a shift in the position of one of the hemispheres, which occurs even in children born at term.
If neurosonography has shown that the newborn has a hypertensive syndrome, then the presence of a brain tumor in the baby should also be suspected.
For an accurate diagnosis and proper treatment, you need to go to the hospital to a neurologist.
In a newborn child, it is a safe and highly informative procedure. A harmless ultrasonic wave allows you to visualize all parts of the complex medulla and the smallest vessels that feed it. It is reflected from various structures of the brain and forms a complete image transmitted to the monitor. Another name for the procedure is neurosonography - a method for painless assessment of cerebrospinal fluid and hemodynamics of the brain.
Preparation and indications
Reliable information about the state of the brain is transmitted to a special device through sensors that are installed on certain anatomical structures that are available only in children - fontanelles. They are a dense membrane between the bone bases, which allows the baby's head to shrink somewhat when passing through the natural passages during childbirth. By the age of one year, the membrane is completely ossified and becomes inseparable from the entire bone skull.
The presence of fontanelles makes it possible to produce an ultrasound of the brain in infants With maximum assessment of brain activity. If the pressure in the cranial cavity rises, the structures help to somewhat kill off the excess volume of fluid through perspiration.
But most fontanelles close up almost immediately after fulfilling their main physiological function, and each full-term baby has only one large bone cleft. Somewhat less often, there is one more small fontanel at a small distance from the large one. They are quite felt by palpation, if you hold your hand from the crown of the baby to the forehead. They are usually soft, may throb, or be visible on examination as small bruises.
Ultrasound NSG with conduction through the fontanelles does not require a preparatory stage in infants. Preparatory nuances are only as follows:
- This procedure is carried out for children in any condition: in a dream or active wakefulness, when the child falls asleep or even cries. This does not distort the results of the study and does not make it difficult to decipher them.
- It is recommended to conduct an ultrasound examination after one and a half hours from the moment of feeding. There is no need to deviate from the diet, as well as feed the child or feed the mother on her own certain foods or milk substitutes.
An ultrasound of the head of the child is carried out according to strict indications. The study is prescribed by a pediatrician or other narrow pediatric specialist for certain conditions of infants to exclude or confirm a particular diagnosis.
The following categories of children undergo ultrasound diagnostics on the brain:
- Infants born during preterm birth, namely before 36 weeks of gestation.
- Babies born at or before term who, for some reason, have an Apgar score of less than 7/7. Preventive ultrasound is also performed in children who screamed after some time from immediate birth.
- Full-term babies whose birth weight has not reached 2800 grams.
- Ultrasound of the head of a newborn is indicated in cases where there are signs of damage to the central nervous system or peripheral ganglia acquired during childbirth or during fetal development. It is also possible to clarify the cause of cerebral hernias or protrusions of the skull with the meninges using an ultrasonic wave.
- With pronounced defects in the external structure, especially in the presence of an additional finger or several rudimentary coccygeal processes, with an abnormal shape of the ears.
- With a sudden onset of a convulsive syndrome in an infant immediately after childbirth or within a day after them.
- In some pathological conditions on the part of the mother: in particular, with rapid or vice versa prolonged labor, a long anhydrous period, with chronic or acute infection during pregnancy, with Rh incompatibility.
These indications recommend conducting an ultrasound of the brain of newborns immediately when they stabilize from the moment of one or another type of delivery. There are also recommendations for the procedure a little later: for children at 1 month of age and later than 3 months.
Ultrasound in infants who have reached the age of 1 month is performed when:
- Carrying out childbirth artificially (during caesarean section) or using any aid to extract the child (use of a vacuum extractor, obstetric forceps).
- Establishment of a non-standard head shape in a child, detection by parents of excessive growth of the head relative to the body.
- At 1 month of life, children diagnosed with birth trauma, cerebral palsy, and convulsive syndrome are subject to repeated ultrasound of the head.
- With other malformations of fetal development: strabismus, paresis of the limbs, underdevelopment of internal organs.
- With unidentified tearfulness or anxiety of the child, with frequent regurgitation and the inability to choose the type of food.
- It is recommended to repeat ultrasound in the first month of life for premature babies at birth, as well as for babies who have gained 2800 grams by the time of birth.
Carrying out an ultrasound of the head is possible up to one year of a child's life, until the fontanelles are completely fused. After 3 months, the procedure is performed:
- To control various neurological abnormalities, to establish the effect of the treatment of birth trauma, intrauterine infection.
- After a child had meningitis or other inflammation of the meninges.
- Children with an inferior set of chromosomes, with another genetic deficiency.
- With head injuries that occurred at the age of less than a year, intracranial hemorrhages, the occurrence of cysts and abscesses in the brain substance.
If ultrasound in newborns and infants under one year does not allow a diagnosis, an MRI under general anesthesia is recommended.
Diagnostic Information
Ultrasound of the brain, as described above, is carried out for babies through the large and small fontanelles. If there is a suspicion of a pathological process in the posterior parts of the organ, it is allowed to conduct a study through the large occipital foramen.
During ultrasound diagnostics, the child is placed on the couch and slightly holds his head. The sensor is placed on a gel-treated skin surface. The doctor simultaneously moves the sensor along the fontanel and with a little effort to the depth to visualize all brain structures. The thin temporal bone during infancy also makes it possible to examine the corresponding parts of the brain if the pathological focus is located on their side.
The doctor can decipher the information received already during the study and notify parents and staff about this. The norm of various parameters for each child depends on at what gestational age the delivery occurred. The most common physiological parameters are:
- The symmetry of the brain structures of both hemispheres.
- The presence of clearly defined furrows and convolutions.
- The thalamus and brain nuclei should be homogeneous in echogenicity.
- Hyperechoic areas should highlight the plexus of arteries and veins.
- For each age, the recommended depth and length of the anterior and lateral ventricles of the brain, certain parameters of the third ventricle and the large cisterna were established.
- The gap separating the hemispheres must also have a certain width and not contain liquid.
- The brain stem should be placed according to the established axis.
- The substance of the brain is examined for the presence of cysts, intracerebral hemorrhages, areas of ischemia and tumors, and the blood vessels supplying the brain - for congenital aneurysms, malformations, and pathological imperfections.
- Separately, the thickness of the meninges and the spaces between them are measured.
Deciphering the found deviations from the norms is carried out with the participation of additional specialists, in particular, a pediatric neurologist and a pediatrician. Their activity determines the necessary treatment, the need for additional diagnostic methods, the presence of dynamics since the previous neurosonography. It is important to compare the received ultrasound information with the clinical picture and the general condition of the child.
Most common diagnoses
The statistics reflect the following most common diseases detected using an ultrasound machine:
- Atypical expansion of the ventricles of the brain. The picture obtained on ultrasound provides information about an increase in one or more deep parameters of the cerebral ventricles. This usually corresponds to the diagnosis of hydrocephalus and its external manifestations: a large head around the entire circumference or only one hemisphere, in some departments; fontanelles may bulge. The main etiology of excessive formation of CSF, which underlies the pathological process, is intrauterine infection. Toxoplasma, cytomegalovirus, and other bacteria mediate poor absorption of cerebrospinal fluid, causing characteristic symptoms and manifestations. Children with this diagnosis suffer from headaches, may lag behind their peers in psychomotor development, be adynamic and lethargic.
- Subarachnoid dilatation is of clinical value only with certain symptoms. High fever, refusal to eat, or frequent regurgitation, together with an enlarged subarachnoid space, suggests meningitis or an adjacent inflammation. Without the described signs, a slightly enlarged space between the meninges is considered normal.
- Vascular cysts. Cerebrospinal fluid is produced in several structures, one of which is the choroid plexus in the ventricle of the brain. For unknown reasons, they develop cysts with fluid-filled cavities. In their clinical course, there is a tendency to self-absorption, and they most often do not manifest themselves symptomatically.
- Unlike vascular cysts, similar arachnoid formations pose a threat to the life and general condition of the child. When they increase to 3 mm, they are able to compress areas of the brain and cause epileptic seizures and other neurological deficits. Such cysts are required for surgical removal, as they are not able to pass on their own.
- Center of ischemia in the medulla. Zones of cerebral ischemia occur when the vessels are dysfunctional, which cease to nourish certain parts of the brain. Ischemic areas can lead to softening of the brain and the further formation of a widespread neurological deficit. In this case, emergency therapy or surgical intervention is necessary.
According to statistics, the absolute norm of the structure of the brain is observed quite rarely. Small formations and pathological abnormalities are prone to self-elimination as the child grows. If a clarifying or re-diagnosis of brain anomalies is not required, vitamin D preparations can help ossify the soft membranes of the bone skull. Its appointment is contraindicated in hydrocephalus and its subspecies.
The first ultrasound for a newly born child is recommended to be done when he is exactly one month old. Ultrasound for newborns (normal) can be a unique way to detect hidden pathologies of internal organs. If any are found, the child can be cured, since the time required for this therapy will not be lost.
Normal ultrasound of the heart in a newborn
Echocardiography of a newborn is included in the list of required examinations that need to be done to a newborn baby before the age of one. Despite this, there is a list of indications for such an ultrasound:
The norms of an ultrasound examination for a child a month old will be as follows:
- LV size (diastole): in infant boys - from 1.9 to 2.5 cm, in infant girls - 1.8 - 2.4 cm;
- LV size (systole): approximately the same in both sexes - from 1.2 to 1.7 cm;
- The wall of the pancreas is 2 to 3 mm thick;
- The septum between the ventricles is 3 to 6 mm thick;
- LA in diameter: in infant boys from 1.3 to 1.8 cm, in infant girls - from 1.2 to 1.7 cm;
- LV in diameter: in infant boys - from 0.6 to 1.4 cm, in infant girls - from 0.5 to 1.3 cm;
- The posterior wall of the left ventricle: in both sexes, its thickness is 3–5 mm;
- The speed of blood passing near the pulmonary valve is 1.3 meters per second.
LV - left ventricle, RV - right ventricle, LA - left atrium.
Ultrasound of a newborn at 1 month: normal brain parameters
Ultrasound of the brain in newborns (normal) is a very important examination. Ultrasound of the brain in newborns (normal) is otherwise called neurosonography. Ultrasound of the head of a newborn and the norms of this study allow us to assess the state of the vessels and blood flow in them, as well as to determine the area where the blood circulation does not correspond to the norm (ischemia) and the infarct area (cells in this area are affected due to insufficient blood flow).
Ultrasound of the brain of a newborn, the decoding (norm) of which is carried out only by a doctor, is also done based on the following indications:
- Too fast or too slow childbirth;
- The weight of the born child is less than 2 kg 800 gr;
- Penetration of infections into the mother's womb during pregnancy;
- The birth of the baby before the thirty-sixth week of pregnancy;
- The absence of a cry at the moment when the baby was born;
- Birth trauma and stay in intensive care after it;
- Brain herniation in a newborn;
- The presence of brain pathology during the passage of a mandatory ultrasound during pregnancy;
- Operation caesarean section;
- Paralysis, strabismus and paresis.
Ultrasound of the head in newborns: the norm and deviations according to the results are as follows:
The ventricles should be cavities containing cerebrospinal fluid. Objectives and indications necessary for the study. If the ventricle is enlarged, it may indicate hydrocephalus, which means the accumulation of cerebrospinal fluid in the skull.
Get a free doctor's consultation
Ultrasound of the brain in infants (neurosonography, NSG) is one of the most informative methods for examining the structures of the brain of the head and blood flow in its vessels, which is based on the effect of an ultrasonic wave.
The sensor of the device sends high-frequency sound waves to the structures of the brain, they are reflected from them, and this forms an image on the screen.
This method is painless, safe, can be carried out repeatedly, does not require special training and the use of anesthesia. NSG makes it possible to assess the state of the medulla itself, its CSF pathways, ventricles, and to analyze hemodynamics.
Preparing for an ultrasound
In infants the study is carried out through fontanelles - areas between certain cranial bones, created by thin structures that resemble a membrane. They are required so that the baby's head, passing through the birth canal, can change its configuration, adapting to the anatomy of the mother. It is precisely because of the presence of fontanelles that with an increase in pressure in the skull for an “extra” volume in the cranial cavity, there is an “emergency exit”.
There are several fontanelles, however, by the time of birth, many of them are closed in a full-term baby, more precisely, they are overgrown with bone tissue.
Only a large fontanel remains (which is palpable on top of the head, it should pulsate, be soft and not be higher than the level of the cranial bones) and in some cases - a small . Through these fontanelles, research is carried out.
For its implementation in children under one year old, no special preparation is required. This method of examination is performed while there is still a large fontanel. Ultrasound can be performed while awake, during sleep, and even if the baby is crying. This will not affect the interpretation of the analysis in any way.
There is only one caveat: if you perform not only neurosonography, but also dopplerography, namely, an examination of the vessels of the brain of the child’s head, then it is necessary that more than 1.5 hours pass after feeding. As for the rest, no special nutrition or sleep is required for the baby during this procedure.
Indications for NSG
Ultrasound of the head in newly born children is performed in the following cases:
Neurosonography at the age of one month is indicated for the following children:
Examination of children under one year old is performed in such situations:
Procedure execution process
As already mentioned, ultrasound of the head of a newborn up to one year is performed through a small or large fontanel, very rarely through the occipital foramen magnum, if you need to examine the structures of the cranial posterior fossa.
The baby is laid on the couch, medical staff or parents hold the baby's head.
A special gel is applied to the site of a large fontanel (if required, also to the occipital region), then an ultrasonic sensor is applied.
After that, the doctor begins to adjust the location of the sensor, taking into account what needs to be considered in the structures of the brain.
In certain cases, even a child who has a fontanel, the sensor is also applied to the area of the temporal bone in order to see in more detail evaluate pathological neoplasms found in the cranial cavity.
Deciphering the results of ultrasound of the head in newborns
The norm of ultrasound of the head in infants depends partly on the period of pregnancy at which the child was born. The following are the mandatory “norm indicators”:
Deciphering ultrasound in one month: all indicators must be exactly the same as above and, in addition:
Deciphering the ultrasound of the brain of the head of newborns is not performed by a doctor who directly examines, but only by a neurologist.
Only this specialist can prescribe adequate treatment for the child, explain the prognosis of the disease, and determine the dynamics of changes in NSG indicators.
Thus, it is important for a neurologist both to evaluate the numbers and echo density data of structures, and to compare all this with clinical indicators, that is, with symptoms that are noted in a particular baby.
For example, increase by a couple of millimeters any of the ventricles, if all other indicators of the ultrasound of the child's brain are normal (and there are no pathological symptoms), it can pass without medical treatment.
Deciphering the most common diagnoses
Deciphering the ultrasound of a newborn in some cases can describe such diseases.
Ventriculodilatation or enlargement of the ventricles of the brain
This is when the indicators that indicate the depth of the ventricle are greater than the above norms. These are symptoms of hydrocephalus, or as it is popularly called, dropsy of the brain. The pronounced symptoms of dropsy can be seen with the naked eye: the head is large, the forehead may protrude, the fontanelles begin to swell.
Hydrocephalus is formed due to some intrauterine infections (cytomegaly, toxoplasmosis), fetal malformations, hemorrhages. In the case of this disease, either a significant amount of cerebrospinal fluid (CSF) appears, or it is poorly absorbed. It is also possible that due to some violations a congestion has formed in the work in the liquor-bearing systems, and the cerebrospinal fluid cannot go along its normal path.
Hydrocephalus begins to create high intracranial pressure, as a result, the baby often has a headache, he may lag behind in physical and mental development, and gets tired faster. This disease is subject to indispensable treatment.
Cysts in the vascular plexus
The choroid plexuses are the cells that line the ventricle and produce cerebrospinal fluid. A cyst is a small cavity that is filled with fluid. As a rule, these cysts do not show any symptoms and do not require treatment, dissolving on their own.
Arachnoid cyst
An arachnoid cyst is a cavitary neoplasm that is filled with fluid in the arachnoid (arachnoid) membrane of the brain. The danger of this formation is more than 3 mm in size is that it compresses a part of the brain or causes seizures of epilepsy. These cysts must be treated without fail, they do not go away on their own.
Ischemic focus in the brain
This means that the vessel responsible for the nutrition of this area has partially or completely stopped doing its job. If there is a softening of the brain (leukomalacia) or a large area, then this means that it will no longer perform its work, and deviations will be observed in the development of the baby.
Features of ultrasound in newborns
If any brain disease is identified, then it is imperative to consult a neurologist regarding the therapeutic or prophylactic use of vitamin D (Aquadetrim): this remedy will help the fontanelles “close” faster, and this can be dangerous, especially if intracranial pressure is noted.
Also, a significant number of pathologies detected during ultrasound of the head in a newborn will require consultation with a neurologist, not only regarding the prognosis, treatment prescription, but also from the withdrawal of various vaccinations.
If the fontanel is very small or has already closed, then only transcranial ultrasound can be performed, it is not as informative as NSG. Or an MRI, which in a certain sense is even better than ultrasound, but will require the provision of sedation (general anesthesia) for the baby.
