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

Roberta Arena; Francesca Gallini; Domenico Umberto De Rose; Francesca Conte; Luca Giraldi; Teresa Pianini; Alessandro Perri; Piero Catenazzi; Luigi Orfeo; Giovanni Vento; Paul Govaert

doi:10.1055/a-1704-1716

American Journal of Perinatology, Table of Contents

Am J Perinatol 2024; 41(04): 488-497
DOI: 10.1055/a-1704-1716

Original Article

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

Roberta Arena

¹Neonatal Intensive Care Unit, “San Giovanni Calibita Fatebenefratelli” Hospital, Isola Tiberina, Rome, Italy

²Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy

,

Francesca Gallini

²Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy

³Dipartimento di Scienze della Vita e Sanità Pubblica, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy

,

Domenico Umberto De Rose

²Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy

⁴Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant, “Bambino Gesù” Children's Hospital IRCCS, Rome, Italy

,

Francesca Conte

¹Neonatal Intensive Care Unit, “San Giovanni Calibita Fatebenefratelli” Hospital, Isola Tiberina, Rome, Italy

,

Luca Giraldi

⁵Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy

,

Teresa Pianini

²Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy

,

Alessandro Perri

²Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy

,

Piero Catenazzi

²Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy

,

Luigi Orfeo

¹Neonatal Intensive Care Unit, “San Giovanni Calibita Fatebenefratelli” Hospital, Isola Tiberina, Rome, Italy

,

Giovanni Vento

²Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy

³Dipartimento di Scienze della Vita e Sanità Pubblica, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy

,

Paul Govaert

⁶Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands

› Author Affiliations

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

Full Text

References

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