Neurosonography of newborns is a method of ultrasound examination of the child’s nervous system in the first year of life. With it, you can diagnose brain pathology in the presence of suspicious signs and symptoms. But it is possible to conduct an ultrasound and screening method. Such an examination is carried out immediately to a large group of clinically healthy babies in order to identify diseases at an early stage.
In this article, we will find out in which cases a neurosonography of the brain is carried out for the baby, how to prepare for the examination, and also how to correctly decode the results.
Survey principle
The principle of neurosonography is based on the formation of waves with a frequency of more than 20 kHz, which are not audible to humans. This wave is called ultrasound. Human tissues absorb and reflect waves in different ways. It depends on the density and speed of propagation of ultrasound.
High density fabrics almost completely reflect the wave. The more fluid body media absorb ultrasound.
Therefore, fabrics of different densities are displayed differently on the monitor. Some are lighter, while others are slightly darker.
When is neurosonography prescribed?
As already noted, an ultrasound examination of the brain can be performed by screening a large group of newborns or an individual child. When prescribing an ultrasound to a specific baby, the doctor looks at a number of symptoms. The examination is shown only to those children who have signs of impaired brain structure.
When do neurosonography do newborns? The doctor gives a direction in the presence of such pathological conditions:
- Strange shape of the baby's head: asymmetrical skull, elongated or too convex forehead, and so on.
- The circumference of the head is greater than the age norm, while other indicators are within its limits.
- An Apgar score of 7 points or less.
- In the appearance of the child, there are features that are characteristic of genetic diseases. These are the so-called stigmas of dysembryogenesis. These include, for example, wide-set eyes, cleft lips, lack of earlobes.
- Disorders of brain development during ultrasound examination of a pregnant woman.
- A premature baby, that is, born before 38 weeks.
- The presence of seizures in the newborn.
- Too fast or, conversely, prolonged childbirth;
- After birth, the child was in the intensive care unit.
- The doctor suspects the development of cerebral palsy.
- Conflict of the mother and child by blood type or Rh factor.
Neurosonography of newborns is done not only for diagnostic purposes. It is also prescribed to monitor the effectiveness of therapy in all of the above conditions.
Survey preparation
One of the main advantages of neurosonography of the brain of newborns is the absence of the need for any preparatory actions. This method is absolutely safe for the baby at any age and in any condition. The examination is carried out only for born children, and at an older age. It can also be carried out in a serious condition of the child in the intensive care unit, in a couveuse.
A study is recommended after meals. So the child is more calm and not so resistant to the examination.
The main condition for the efficient decoding of neurosonography of a newborn is an open large fontanel. It is located between the frontal and parietal bones and has the shape of a rhombus. As a rule, this structure closes during the first 12-18 months of the child's life. Therefore, ultrasound of the brain is shown only in this period of time.
If necessary, it is possible to examine the brain and through the other fontanelles. But then the diagnostic value of the method decreases, since the review through them is much worse.
How is the survey
Neurosonography of a newborn takes about 10 minutes. At this moment, the child should lie as calmly as possible. He is not given anesthesia or other sedatives. They just ask mom to hold the baby's head.
A small amount of gel is squeezed onto a large fontanel. This is a necessary measure to eliminate image noise when the sensor is rubbed against the skin surface.
After carrying out all the preparatory procedures, the doctor applies the sensor to the gel. At this moment, an image appears on the computer monitor. The doctor moves the sensor, changing its angle and location, to carefully examine all the underlying structures.
Next, the decoding of the neurosonography of the brain of the newborn occurs. The doctor describes in detail everything he saw. But he does not make a final diagnosis. This is done by the attending physician of the baby on the basis of the clinic, objective examination data and ultrasound examination.
What can be seen with the survey
Using ultrasound neurosonography of a newborn, one can see the cerebral cortex, white matter, and the system of brain cavities (ventricles) in which cerebrospinal fluid (cerebrospinal fluid) circulates. Four ventricles of the brain are isolated.
The structures of the brain stem are clearly visible: the midbrain, thalamus and medulla oblongata. You can also consider the part of the nervous system that is responsible for the coordination of movements. It is called the cerebellum.
With the help of neurosonography, it is possible to diagnose a violation of the structure of the brain even before the onset of the first symptoms. Diagnosis of intracranial hypertension is also possible due to indirect signs. With this pathology, ultrasound shows an increase in the size of the ventricles, especially the first and second.
How to describe brain structures
When writing a conclusion on neurosonography, the doctor consistently characterizes all the brain structures that he managed to see.
He notes the symmetry of brain structures. Normally, with neurosonography of newborns, all formations are symmetrical.
Next, the doctor goes on to describe the cerebral cortex, namely the furrows and convolutions. They should be clearly visible, not interrupted.
When characterizing the ventricles, their echogenicity, symmetry are noted, they look if there are any inclusions. Normally, echogenicity is moderate, the structure is homogeneous, the ventricles are absolutely symmetrical, there are no inclusions.
The cerebellum has a trapezoid shape, located in the back of the head. The crescent process is a thin strip with increased echogenicity. The vessels are homogeneous, their echogenicity is also increased.
If the doctor noted the presence of any pathological formations (cysts, areas of softening of the brain tissue), he describes them at the end after all the structures.
Ventricular volumes are normal
Description of the ultrasound of the brain includes not only the characteristic of tissue structures, but also the volume of hollow formations - ventricles and spaces between the shells of the brain. When decoding the neurosonography of a newborn, normally these spaces have the following dimensions:
- the body of the first or second ventricle (they are symmetrical) - the depth is 4 mm;
- anterior horn of the first ventricle - depth up to 2 mm;
- gap between the hemispheres of the forebrain - up to 2 mm;
- third ventricle - up to 6 mm;
- space under the arachnoid meninges - width up to 3 mm.
- large tank - from 4 to 6 mm.
The neurosonography rate of a newborn at 1 month is slightly different from that in babies of other ages. There are some differences in the ventricular volume of older children from newly born babies. So, the size of the cavity structures in the brain progressively decreases as the child grows. For example, the dimensions of a large tank are reduced to 4 mm. And the body of the first ventricle has a depth of up to 3 mm.
Deciphering the pathology
Most often, with the help of neurosonography of newborns, the following diseases are diagnosed:
- brain cysts;
- a brain tumor;
- hydrocephalus;
- ventricular hemorrhage or brain parenchyma;
- ischemic damage to brain tissue.
The cyst of the brain is very clearly visible by ultrasound. It is a cavity in the brain substance of a round or oval shape with smooth walls. Inside it may be content. There are several types of cysts:
- Vascular plexus - occur in the place where cerebrospinal fluid is synthesized. Occur during childbirth or in the prenatal period. They are usually small and do not require any treatment.
- Subependymal - located near the ventricles of the brain. Appear after damage to brain tissue by ischemia or hemorrhage. They can grow, therefore, they require further observation.
- Subarachnoidal - localized under the arachnoid meninges. If they are found, a neurologist consultation and treatment are required.
Increased intracranial pressure
Hypertension syndrome, or high intracranial pressure, is another common condition for the appointment of an ultrasound examination. The most common cause of this condition is the excessive accumulation of cerebrospinal fluid in the cavities of the brain. But other pathologies are possible: a brain tumor, large cysts, hematomas, inflammation of the brain tissue.
Hydrocephalus is one of the causes of intracranial hypertension. With this pathology, cerebrospinal fluid accumulates in excessive quantities due to an increase in its production, impaired absorption or the presence of an obstruction in the circulation. As a result, the brain is disturbed, there are constant headaches. The child is tired, develops poorly.
Timely neurosonography is an effective prevention of these serious consequences. The monitor will show the expansion of the ventricular system. But do not be alarmed if you see such a phrase in the transcript of ultrasound of your child. Ventricular enlargement is not a guarantee of hydrocephalus.
There is a disease called ventriculomegaly. Literally translated as "large ventricles." In the absence of clinical symptoms and cavity growth, no treatment is required. It is only important to regularly conduct neurosonography and monitor these structures. Treatment is necessary with the progression of pathology and the appearance of symptoms.
Ventricular hemorrhage
Neurosonography is also effective in the diagnosis of blood flow into the system of brain cavities. Hemorrhages are most often determined in the first days of a child’s life. There may be several reasons for this condition:
- infectious damage to the brain;
- blood clotting disorder (hemophilia, idiopathic thrombocytopenic purpura);
- hemolytic disease of the newborn;
- birth injury;
- asphyxia.
When making a diagnosis of hemorrhage, not only the data of neurosonography, but also the clinical manifestations are taken into account. Depending on them, the severity of the pathology and the need for treatment are determined. So, with hemorrhage of the first degree there is no need for treatment, observation of the patient is enough. And in more severe stages, appropriate therapy is prescribed.
Other ultrasound methods
Most often, neurosonography is performed through the large fontanel of the baby. But there are other ways to conduct this examination:
- transcranial - through the temporal bones of the skull;
- transcranial-transgenital - the examination technique through the fontanel and temporal bone are combined;
- through defects in the cranial bones - after surgical interventions on the brain.
Previously, it was believed that examination of the brain is not possible through bone structures. But, to increase the diagnostic value of the method with a closed large fontanel, scientists were able to invent new ultrasonic sensors.
Where can I do an examination
Neurosonography of newborns in Yekaterinburg can be done in many private medical centers:
- Medical Center "SMT Clinic".
- Medical center "Vimed".
- Clinic "NovaMed".
- Medical Center "Medline".
- Medical Center "Health Plus".
The price of the service ranges from 600 to 1000 rubles.