Prediction of death and major handicap in very preterm infants by brain ultrasound.

A linear-array real-time ultrasound scanner was used to examine the brains of all 95 infants born at less than 33 weeks of gestation who were admitted to the neonatal unit of University College Hospital in 1979. Abnormalities were detected in 41 (43%). 36 infants had haemorrhages into the germinal layer (GLH) and/or ventricles (IVH). 8 infants had cerebral atrophy (together with GLH/IVH in 5 infants). 8 (13%) of 63 infants with normal scans or small (grade-I) GLH/IVHs died, whereas 19 (59%) of 32 infants with larger haemorrhages or other intracranial lesions died (p less than 0.0005). At follow-up, at a median corrected age of 45 weeks, only 2 (4%) of 53 infants with normal scans or grade-I haemorrhages had evidence of major neurodevelopmental handicaps, but 5 (38%) of 13 infants with more extensive haemorrhages or cerebral atrophy had major handicaps (p less than 0.005). Brain scanning with ultrasound in the first days of life identified most infants in the population studied who subsequently died or survived with handicaps severe enough to be detected within the first year.