Neurosonography of newborns: norms, indications, methods of conducting

The term "neurosonography" (NSG) combines at once 3 words: the Greek "neuron" - the nerve and "grapho" - to represent, Latin "sonus" - sound, means the method of studying the organs of the nervous system with the help of ultrasound. As a rule, this term, the synonym of which is "ultrasonography" (USG), means studying the brain exclusively through a large fontanel, but this is not entirely true: it combines a whole group of techniques, among them the USG of the skull, the soft tissues of the head, the brain and spinal cord, the spine, and others. But really, the most common technique of the NSG is the study of the brain itself. About how it is conducted, about indications and contraindications, about the principles of deciphering the NSH of newborns you will learn from our article.

Types of cerebral ischemia

There are 4 research methods that differ in the application area of ​​the sensor:

• through the large fontanel - the overgrown NSC;
• through the bones of the skull (usually through the temporal, less often through the parietal) - transcranial USG;
• a combined technique - through a large fontanel and bones of the skull - an overgrown-overcranial USG;
• USG through defects in bone tissue.

In the overwhelming majority of cases, newborns and children of the first year of life are given an overgrowth neurosonography, but sometimes, with suspicion for some serious diseases, a study with a combination of overgrowth and transcranial techniques is preferable. It is this study that provides the maximum possible examination of the brain and other structures of the child's intracranial space.

Indications and contraindications

All neonates are recommended at least once a neurosonography.

Ideally, neurosonography should be performed at least once for each newborn. This is due to the fact that some brain diseases can be hidden, asymptomatic for even a few years, and when there are complaints and will be diagnosed, the brain will already determine irreversible changes that will not be eliminated. USG will help to diagnose these diseases in time, and therefore, to detect pathology at its early stage. Unfortunately, in our time, ultrasound examination of the brain of newborns can not become a screening method of diagnosis - it is not available, primarily for economic reasons.

In certain situations, neurosonography is indispensable. Indications for its conduct are:

• birth of a child before the due date (prematurity);
• pathological (prolonged or rapid) delivery;
• prolonged anhydrous period;
• children born by caesarean section, with low body weight;
• the pathology of the development of the brain, revealed on ultrasound during pregnancy;
• an Apgar score at birth of less than 7/7;
• resuscitation measures for the child;
• birth injury;
• suspicion of hydrocephalus;
• suspicion of cerebral palsy;
• frequent regurgitation, delayed psychomotor development, seizures or other symptoms of neurological pathology;
• any vices of internal organs;
• suspected intrauterine infection;
• chromosomal pathology;
• Rhesus-conflict or blood group conflict;
• evaluation of the effectiveness of treatment of brain pathology.

Contraindications to neurosonography do not exist, therefore the technique is widely used for examining children, including young children, all over the world.

Methodology of the study

Neurosonography is absolutely safe, painless and highly informative diagnostic method, which does not require any special preparation. It can be carried out both to the awake and to the sleeping child, both in the outpatient setting, and in the hospital, even the crumb located in the cuvée.

The use of sedatives or anesthesia is not required: throughout the study the child is conscious or asleep naturally.

The duration of the study is approximately 10 minutes, during which the child lies on the couch or in the cuvse / crib, and the mother or medical worker holds the head to him to achieve immobility.

On the area of ​​the big fontanel of the infant's head, the doctor applies a special hypoallergenic gel for ultrasound, puts a sensor on her and monitors the dynamic image on the monitor screen. It gradually changes the position and angle of the sensor to get a clear image of different planes and structures of the brain.

It is possible to conduct an overgrowth study only until the moment of its ossification, and this occurs, as a rule, at the age of 1 year of the child. Moreover, with each month the fontanel becomes less and less, which means that the research becomes less informative - it affects a smaller area of ​​the brain. That is why it is recommended to carry out diagnostics during the newborn period or in the first months of the child's life. If any changes are detected with NSH, then the study is repeated to evaluate the effectiveness of the treatment or control of the course of the disease. When the area of ​​the fontanelle is closed with a bone tissue, transcranial neurosonography, or MRI and CT, will remain an available method of investigation.

What will the NSG show and how to decipher it?

During the study, the specialist examines all brain structures, determines their size and assesses the structural state of the tissues. Thus, tumor formations, foci of ischemia, hemorrhages, the presence of fluid and the developmental defects of the brain structures can be diagnosed.

The doctor necessarily writes the protocol of the study, which indicates:

• whether the structures of the brain are symmetrical;
• whether furrows and gyruses are clearly visualized;
• Does the interhemispheric gap contain a liquid?
• characteristics of the ventricular system of the brain (in norm they are homogeneous, anehogennye, symmetric, without extraneous inclusions);
• Characteristics of the crescent process (normal - hyperechoic band);
• the characteristics of the nasal of the cerebellum (in a healthy child it is located in the occipital region, has a trapezoidal shape, is symmetrical);
• characteristics of vascular plexuses (they are hyperechoic, have a homogeneous structure);
• Are there any special pathological changes - cysts, tumors, malformations, softening of brain tissue (leukomalacia).

Also in the minutes of the NSG, the size of the following structures should be indicated:

• interhemispheric cleft;
• the anterior horn of the lateral ventricle;
• the body of the lateral ventricle;
• the third ventricle;
• large tank;
• subarachnoid space.

Due to the fact that the child's brain is actively growing and developing, the size of its structures varies depending on the age of the subject. Conversely, in the brain of the child, regardless of its age, foci of hemorrhage, ischemia, leukomalacia, thickening of tissues and structures, and their asymmetry should not be detected. In the event that such changes do occur, the child should be referred to a neurologist for co-counseling.

Let us consider in more detail some pathological changes in the brain that can be detected in the NSH.

1. Hypertensive syndrome. If there is such a record in the study protocol, this means that the pressure in the cranial cavity is increased. The cause of its increase is any volumetric process: hemorrhage, cyst or other tumor-like formation. This condition leads to the displacement of one of the hemispheres, which can lead to serious neurological disorders.
2. Hydrocephalus. Such a diagnosis is established based on the detection of an increase in one or more ventricles in the brain in size. This means that they have accumulated a large amount of cerebrospinal fluid, which is either produced in more than necessary quantity, or does not have a path of outflow from the cranial cavity. The condition requires consultation of a neurologist, adequate treatment and neurosonography in the future to evaluate the effectiveness of therapeutic measures.
3. Hemorrhage into the substance of the brain or the ventricles. This condition requires urgent treatment, so a child with such a diagnosis should be immediately hospitalized and examined by a children's neurologist.
4. Cysts of the vascular plexus. They have the form of bubbles of small diameter, filled with liquid, localized in the area of ​​cerebrospinal fluid production. They can be single or multiple. Occur during fetal development or during childbirth. As a rule, this condition is asymptomatic and does not require treatment.
5. Subependymal cysts. Also localized in the area of ​​the ventricles of the brain and have the appearance of a system of cavities filled with liquid. Occur due to ischemia (lack of oxygen) tissues of the site or hemorrhage in them. In most cases, they are asymptomatic, however, if the cause of their occurrence is not eliminated, cysts can grow. They require treatment and follow-up in dynamics.
6. Arachnoid cyst. It is formed by the cells of the arachnoid membrane of the brain due to the infectious process, traumatic injury, hemorrhage. It has the appearance of a cavity of any size and shape, it can be localized in all parts of the brain. Characterized by rapid growth, later leads to squeezing the adjacent brain tissue and the development of appropriate neurological symptoms. It does not disappear by itself, requires consultation of a neurologist and appropriate treatment.
7. The focus of ischemia. Such a record in the protocol indicates that a certain area of ​​the brain (not necessarily one, multiple foci of ischemia is possible) lacks oxygen. It can lead to serious consequences, therefore, requires treatment followed by a control neurosonography.

So, neurosonography is a highly informative, completely safe and painless method of diagnosing brain diseases in newborns and children of the first year of life. Often it allows you to establish the correct diagnosis, even at the preclinical stage, when there are no external manifestations of the disease yet, and structural changes in the brain tissue already exist. This helps to start treatment on time, which means it increases the chances of a sick child to recover.

Dr. E. ABOUT. Komarovsky talks about neurosonography: