André M. Graça

Preterm cerebellum at term age: ultrasound measurements are not different from infants born at term

Background:Reduced supratentorial brain growth has been shown in preterm-born infants at term-equivalent age (TEA), but cerebellar growth may be preserved in the absence of supratentorial injury. Our study aims to compare cerebellar size assessed using cerebral ultrasound (cUS) at TEA between preterm infants and term-born controls.Methods:Cerebellar dimensions (including transverse cerebellar diameter (TCD), cerebellar vermis height, anteroposterior vermis diameter (APVD), and cerebellar vermis area (CVA)) were measured using Image Arena software (TomTec Imaging Systems, Unterschleissheim, Germany) in 71 infants <32-wk gestation without significant scan abnormality at TEA and in 58 term-born control infants. Intra- and interobserver agreement were evaluated.Results:In comparison with controls, preterms at TEA had smaller TCDs (4.9 vs. 5.2 cm; P < 0.001) but larger CVAs (4.7 vs. 4.3 cm2; P < 0.005) and APVDs (2.4 vs. 2.2 cm; P < 0.001); however, these differences were no longer seen after accounting for head shape. In <28-wk gestational age infants, CVA was statistically similar to controls, as were for small-for-gestational-age infants.Conclusion:Our data support neonatal sparing of preterm cerebellar growth that is measureable using cUS, and this includes the most immature and small-for-gestational-age infants. We suggest cUS can be used to assess cerebellar size at TEA, with measures of both width and height being taken into account, and thus may be a useful tool for detecting infants with poorer cerebellar growth who are at increased risk of disability.

Assessment of gestational age using cerebellar measurements at cranial ultrasound: What is the best approach?

BACKGROUND AND AIMS Clinical assessment of gestational age (GA) in preterm infants can be challenging. Several ultrasound approaches for estimating GA using cerebellar measurements are reported, claiming to be simpler and more accurate than clinical assessment, but they are not widely used. We aimed to compare the accuracy of four previously described measurements and compare their use in preterm infants. METHODS We studied infants <32weeks of GA defined by in-vitro fertilization date or early fetal ultrasound, excluding infants with neurological problems. Vermis anterior-posterior diameter (VAPD), vermis height (VH), and transverse cerebellar diameter via anterior (TCDa) and mastoid fontanelles (TCDm) were measured.Estimated PMA was calculated using published equations, and compared to known PMA using intraclass correlation coefficient (ICC). Intra and inter-observer reliability were determined. RESULTS We studied 80 infants (mean GA 28.5weeks [range 24-32], mean post-natal age 5.7days). ICC was 0.761 (VAPD), 0.632 (VH), 0.115 (TCDa) and 0.825 (TCDm). The TCDm equation gave the best estimate of GA (mean estimate -2days; 95% CI±13.8days). TCDa and TCDm absolute measurements were similar for each infant. Accuracy for estimating GA was similar for appropriately grown and small-for-gestation infants. Inter and intra-observer reliability was very good for all measurements. CONCLUSIONS Three previously described equations for estimating GA from cerebellar measurements gave good estimates of GA in preterms. The equation described for TCDm gave the narrowest 95% CI. We recommend the TCDm equation for the estimation of GA in VLBW infants but the TCD measurement can be made via either the anterior or mastoid fontanelle.

Therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy: temperature control during transport

This study aims to assess the adequacy of temperature control during transport of patients referred for therapeutic hypothermia at our centre and to evaluate the occurrence of complications when temperature control is not adequate. Transport data of patients (n = 37) referred during a period of 30 months was reviewed retrospectively, as well as our prospectively collected database of infants treated with hypothermia. We evaluated duration of transport, incidence of excessive cooling on admission and associated complications. Distance from the referring hospital and duration of the transport were not associated with excessive cooling. We then divided patients into two groups according to adequacy of temperature control during transport depending on the presence or absence of regular temperature recordings and compared study variables between the groups. A significant correlation was found between the lack of adequate temperature records during transport (n = 19) and excessive hypothermia on admission (42% vs. 11% for the group with adequate temperature monitoring). There was a trend towards increased incidence of coagulation problems for infants who had admission temperatures below 32.0°C. Passive cooling is simple and effective to ensure early achievement of neuroprotective temperature, but continuous temperature monitoring during transportation is mandatory in order to avoid excessive cooling.

201 Assessment of Gestational Age in Very Preterm Neonates Using Cerebellar Measurements at Cranial Ultrasound - What is the Best Approach|[quest]|

201 Assessment of Gestational Age in Very Preterm Neonates Using Cerebellar Measurements at Cranial Ultrasound - What is the Best Approach?