NICU - Head Ultrasound

ExitCare ImageAn ultrasound scan of the head is done by placing an ultrasound probe over the soft spot on a baby's head (fontanelle). Ultrasound uses harmless, painless sound waves to paint a picture of the body's brain. Pregnant patients may have had an ultrasound of the growing baby sometime during the pregnancy. Ultrasound is a safe, painless, noninvasive procedure. No X-rays are involved.

A head ultrasound tests for bleeding inside the head (intracranial hemorrhage). This is a common problem for babies who are born prematurely.

It is difficult to predict the presence or absence of intracranial hemorrhage by examination. So all infants weighing less than 1500 grams (about 3 ⅓ pounds) have a series of ultrasounds. Even if your baby weighs more than this, the screening may be recommended due to prematurity and other factors.

Screening Schedule:

  • At 5 to 7 Days After Birth: First head ultrasound.

  • At 28 to 30 Days After Birth: Second head ultrasound.

  • At 40 to 45 Days After Birth: Third head ultrasound (only necessary for babies born at 26 weeks gestation).

There are 4 major types of intracranial hemorrhage that may affect the baby. These are:

  1. Periventricular-intraventricular hemorrhage (PVH-IVH). In the intensive care nursery, PVH-IVH is the most common of the 4.

  2. Subdural hemorrhage.

  3. Primary subarachnoid hemorrhage.

  4. Intracerebellar hemorrhage.

It is unknown why these bleeding problems develop. It is important to monitor the bleeding with a series of ultrasound studies to see if complications of bleeding develop. A series of head ultrasounds can help your caregiver know early if this complication is developing. There are 3 main complications that your caregiver watches for:

  • Hydrocephalus. This is a condition of excessive fluid in the brain. Hydrocephalus was once known as "water on the brain". The "water" is actually cerebrospinal fluid (CSF). CSF is a clear fluid that surrounds the brain and spinal cord. Normally, CSF flows through a kind of "plumbing" system surrounding the brain and spinal column. An intracranial hemorrhage can damage the "plumbing" and block the normal flow and/or absorption of CSF. The excessive accumulation of CSF results in an abnormal widening of spaces in the brain called ventricles. This widening creates potentially harmful pressure on the tissues of the brain and may interfere with normal brain growth.

  • Porenchephaly. This is a condition that involves the development of an enclosed cavity in the brain (cyst). The size and location of the cyst can cause damage to the brain.

  • Periventricular leukomalacia. This is a condition that involves softening of the tissue next to the ventricles of the brain. In premature babies, this may be caused by less than adequate oxygen delivery to the brain. The damage caused by the softening of the tissue can lead to a hemorrhage.

Damage to the brain from these conditions can lead to:

  • Delayed growth and development.

  • Slight or incomplete paralysis (spastic hemiplegia).

  • Low muscle tone(hypotonia).

  • Twitching or shaking (seizures).

  • Large head (macrocephaly).

  • Small head (microcephaly).

  • Poor or absent speech development.

  • Shrinkage or shortening of the muscles (spastic contractures).

  • Mental retardation.

If hydrocephalus is worsening, your caregiver might request that you consider a surgical procedure called an intraventricular shunt. A shunt is a flexible but sturdy plastic tube that diverts the flow of CSF from the brain to another area of the body where it can be absorbed normally. This can help to prevent further damage to the brain.

RISKS AND COMPLICATIONS

There are no risks to the baby.

BEFORE THE PROCEDURE

The skin over the soft spots (fontanelles) of the skull are cleaned and gently dried before the procedure. There are no other specific preparations needed before the test is done.

PROCEDURE

  • A gel is gently rubbed over the baby's fontanelles. This gel provides better contact between the ultrasound transducer and your baby's skin.

  • As the study begins, the technician doing the study (ultrasonographer) will place a hand-held wand (transducer) against your baby's skin and pass it over the area being studied.

  • Images are collected. They are saved for later review by the radiologist.