Re-evaluating the timing of sequential cranial ultrasound screening in very preterm infants for predicting neurodevelopmental outcomes: A Population Study

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Abstract
Objective: The accurate prediction and early detection of neurodevelopmental impairment (NDI) is a crucial endeavor in caring for very preterm infants (VPI). Sequential cranial ultrasound (CUS) is the standard of care for imaging evaluation. There is no consensus on the timing and frequency of CUS screening. At our institution four time points CUS are performed for screening. We hypothesize that the 2-week CUS is not necessary for NDI prognostication. Materials and methods: In this retrospective, multi-center, population-based cohort, we included all liveborn VPI born 220-306 weeks gestation between January 2004 and December 2018 who had a neurodevelopmental assessment at 36 months corrected age. A model with and without 2-week CUS was compared to a reference model including gestational age, infant sex, and 6-week CUS. Results: Out of 786 preterm babies born during the study period, 656 survivors were included in the analysis. 30% of our cohort has NDI as per clinical assessment. The mean gestational age was 27.8 weeks with the mean birth weight being 1133 grams, and 55% being male infants. One in three survivors developed NDI when assessed at 36 months of corrected age. There was no strong evidence that the addition of the 2-weeks CUS meaningfully contributes to the risk prediction of any NDI or major NDI. Models with and without the 2-week CUS showed nearly identical performance across a broad set of metrics. Conclusion: The comparison of two methods of sequential CUS screening showed reliable performance of the 3-time points model to predict NDI at 36 months of corrected age.

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