Brain Growth Evaluation Assessed with Transfontanellar (B-GREAT) Ultrasound. Old and New Bedside Markers to Estimate Cerebral Growth in Preterm Infants: a Pilot Study

Abstract

Objective We aimed to investigate the feasibility of evaluating overall preterm brain growth using a gathered set of measurements of brain structures in standard cranial ultrasound planes. We called this method of assessment Brain Growth Evaluation Assessed with Transfontanellar ultrasound (B-GREAT).

Study design In this prospective observational cohort study, cranial ultrasound was regularly performed (on day 1, 2, 3, and 7 of life, and then weekly until discharge, and at term) in preterm infants born with gestational age (GA) less than 32 weeks. We evaluated corpus callosum length, corpus callosum–fastigium length, anterior horn width, frontal white matter height, total brain surface, deep grey matter height, hemisphere height, transverse cerebellar diameter in the axial view, and transverse cerebellar diameter coronal view. Measurements obtained were used to develop growth charts for B-GREAT markers as a function of postmenstrual age. Reproducibility of B-GREAT markers was studied.

Results A total of 528 cranial ultrasounds were performed in 80 neonates (median birth GA: 28⁺⁵ weeks and interquartile range: 27⁺³–30⁺⁵). The intraclass correlation coefficients for intra-observer and inter-observer analyses showed substantial agreement for all B-GREAT markers. Growth curves for B-GREAT markers were developed.

Conclusion B-GREAT is a feasible and reproducible method for bedside monitoring of the growth of the main brain structures in preterm neonates.

Key Points

• Overall neonatal brain growth is not routinely monitored using ultrasound.

• Old and new markers were used to build a standardized and non-invasive tool to monitor brain growth.

• All B-GREAT measurements had a good intra-observer and inter-observer agreement.

Keywords

cranial ultrasound - neonates - neurodevelopmental outcome - ultrasound markers - brain growth

Authors' Contributions

All authors have made substantive intellectual contributions to the study conception and design, acquisition of data, or analysis and interpretation of data. They have all contributed to the drafting of the article or revising it critically for important intellectual content and have given final approval of the version to be published.

Publication History

Received: 14 June 2021

Accepted: 15 November 2021

Accepted Manuscript online:
23 November 2021

Article published online:
04 January 2022

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