Nwafor-Anene Victoria N, DeCristofaro Joseph D, Baumgart Stephen
Division of Neonatology, Department of Pediatrics, University Hospital and Medical Center, State University of New York at Stony Brook, Stony, New York 11794-8111, USA.
J Perinatol. 2003 Mar;23(2):104-10. doi: 10.1038/sj.jp.7210869.
We hypothesized that preterm infants with two normal head ultrasound (HUS) screening studies > or = 7 days apart would have subsequently normal follow-up studies.
We reviewed reports of all HUS studies performed in preterm infants < or = 32 weeks gestation admitted to our nursery between January 1998 and July 2000.
Regional perinatal referral center.
A normal HUS screening study was defined as either no findings; or grade I intraventricular hemorrhage (IVH) (Papile classification), germinal matrix irregularity or cyst, or normal but unequal ventricular size. An abnormal study was defined as any with IVH > or = grade II, periventricular leukomalacia (PVL), ventriculomegaly (VM), or periventricular echogenicity (PVE).
Of 98 infants, 92 infants (94%) who had two normal HUS studies > or = 7 days apart had normal repeat studies subsequently, and six (6%) were abnormal. Four of the six abnormal infants were <25 weeks gestation at birth. One infant (27 weeks) became abnormal after culture-positive bacterial sepsis and necrotizing enterocolitis with bowel perforation requiring surgery. The remaining infant (29 weeks) had a question of PVE, and a normal repeat study. The positive predictive value for having a normal HUS after two previously normal studies > or = 7 days apart was 94% with a specificity of 86%.
Stable premature infants > or = 25 weeks gestation without intervening deterioration may not need repeat screening HUSs after having had two normal studies > or = 7 days apart. Unstable or extremely premature infants <25 weeks gestation may be subject to late severe IVH, VM, and PVL, and therefore need a repeat study before hospital discharge, even if two initial studies > or = 7 days apart were normal.
我们假设间隔≥7天进行两次头颅超声（HUS）筛查均正常的早产儿随后的随访研究结果也会正常。
我们回顾了1998年1月至2000年7月间入住我院新生儿重症监护室的孕周≤32周的早产儿所有HUS检查报告。
地区围产期转诊中心。
正常的HUS筛查结果定义为：无异常发现；或Ⅰ级脑室内出血（IVH）（Papile分级）、生发基质不规则或囊肿，或脑室大小正常但不对称。异常检查结果定义为任何伴有≥Ⅱ级IVH、脑室周围白质软化（PVL）、脑室扩大（VM）或脑室周围回声增强（PVE）的情况。
98例婴儿中，92例（94%）间隔≥7天进行的两次HUS筛查均正常，随后的复查也正常，6例（6%）复查结果异常。6例异常婴儿中有4例出生时孕周＜25周。1例婴儿（27周）在培养阳性的细菌性败血症和坏死性小肠结肠炎伴肠穿孔需要手术治疗后出现异常。其余婴儿（29周）存在PVE问题，但复查结果正常。间隔≥7天进行的两次HUS检查均正常后，HUS复查结果正常的阳性预测值为94%，特异性为86%。
孕周≥25周且病情稳定、未出现病情恶化的早产儿，间隔≥7天进行两次HUS检查均正常后，可能无需再次进行筛查。孕周＜25周的不稳定或极低出生体重早产儿可能会出现晚期严重IVH、VM和PVL，因此即使最初的两次检查间隔≥7天且结果正常，在出院前仍需再次进行检查。
