Ultrasound abnormalities preceding cerebral palsy in high-risk preterm infants

J Pediatr. 2004 Jun;144(6):815-20. doi: 10.1016/j.jpeds.2004.03.034.


Objective: To assess sequential high-resolution cranial ultrasound (US) in high-risk preterm infants to predict cerebral palsy (CP).

Study design: Preterm infants were prospectively studied (n=2139), 1636 <or=32 weeks gestational age (GA) (group A) and 503 with a GA of 33 to 36 weeks (group B). US was performed once a week until discharge and at 40 weeks postmenstrual age (PMA), using a 7.5-MHz transducer. Grade III and IV hemorrhage, cystic periventricular leukomalacia (c-PVL), and focal infarction were considered major US abnormalities. A diagnosis of CP was made at a minimum age of 24 months.

Results: Seventy-six (5%) of the 1460 survivors in group A developed CP. US abnormalities were present in 70 of 76 (92%) infants, being major in 58 (83%) and minor in 12 (17%). In 29% of the CP cases with major US abnormalities, cysts were first detected beyond day 28. A further 6 infants without US abnormalities developed CP, and 3 of these infants developed ataxic CP. Twenty-nine (6%) of the 469 survivors in group B developed CP. US abnormalities were present in 28 of 29 (96%) infants, being major in 25 (89%) and minor in 3 (11%). One infant without US abnormalities developed CP. Considering the major US abnormalities, a specificity of 95% and 99% and a sensitivity of 76% and 86% were found for group A and B, respectively. The positive predictive value was 48% in group A and 83% in group B.

Conclusion: Seventy-nine percent of our CP cases had major US abnormalities. To detect c-PVL, the most predictive US marker for CP, sequential scans with a 7.5-MHz transducer are required.

Publication types

  • Evaluation Study

MeSH terms

  • Cerebral Palsy / diagnostic imaging*
  • Cerebral Palsy / epidemiology
  • Cerebral Palsy / pathology
  • Cerebrovascular Disorders / diagnostic imaging*
  • Cerebrovascular Disorders / epidemiology
  • Cerebrovascular Disorders / pathology
  • Echoencephalography*
  • Humans
  • Infant, Newborn
  • Infant, Premature*
  • Leukomalacia, Periventricular / diagnostic imaging
  • Leukomalacia, Periventricular / epidemiology
  • Leukomalacia, Periventricular / pathology
  • Netherlands / epidemiology
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Sensitivity and Specificity