• To detect:
  
  • brain injury in at-risk babies to provide appropriate medical management 
  • lesions associated with long-term adverse neurodevelopmental outcome

Indications

• Gestation <33 weeks
• Birth weight <1500 g
• Ventilated 
• Abnormal neurology 
• Abnormal clotting 
• Congenital abnormalities/significant dysmorphic features 
• Cranial malformation suspected antenatally/family history of cranial malformations
• Maternal cocaine use in pregnancy and head circumference <10^th centile and lower centile than weight 
• Micro/macrocephaly 

Minimal schedule for scans:

Additional scans

• If routine scans show a significant abnormality, discuss serial scanning with consultant
• Perform additional scans as clinically indicated or following a significant clinical event:
  
  • necrotising enterocolitis
  • major collapse 
  • repeated severe episodes of apnoea and bradycardia
  • unexplained sharp fall in Hb
  • change in neurological status 
  • abnormal head growth
  • pre- and post-operatively

Follow-up

• If scan abnormal further follow-up as advised by consultant 

Indications

• Neonatal encephalopathy/ischaemic brain injury 
• Seizures
• Abnormal neurological signs (e.g. floppy child, large head)
• Congenital abnormalities (except trisomy 21) e.g. congenital cardiac abnormality, congenital diaphragmatic hernia 
• Unexplained poor feeding at term
• Unexplained hypoglycaemia, looking for pituitary and midline structures
• Meningitis
• Congenital viral infection
• Metabolic disorders
• Suspected brain malformations
• Significant maternal alcohol intake during pregnancy
• Requiring ventilation – including all babies having surgery under general anaesthetic 

Seizures

In term babies with seizures, perform cranial ultrasound on admission and at 2 and 7 days while waiting for MRI scan (preferred imaging modality)

Neonatal encephalopathy

• Initial scan within 24 hr 
  
  • 2^nd scan 3–4 days
  • 3^rd scan 7–14 days
• In encephalopathic babies with significant birth trauma and low haematocrit, request non-contrast CT scan to exclude extra-axial bleed
• For babies with moderate-to-severe encephalopathy, MRI scan recommended 
  between 5–14 days of life

• Record minimum set of coronal images (6+):
  
  • anterior to frontal horns of lateral ventricles
  • at anterior horns of lateral ventricles and Sylvian fissures
  • at 3^rd ventricle and thalamus
  • at posterior horns of lateral ventricles (with choroids)
  • posterior to choroids (posterior brain substance)
  • if lateral ventricles are dilatated, measure ventricular index at the level of 3^rd ventricle at the foramen of Munro (ventricular index) and plot on appropriate chart
• Record minimum set of sagittal images (5+):
  
  • midline through 3^rd ventricle, cavum septum pellucidum, cerebellum with 4^th ventricle and foramen magnum
  • through each lateral ventricle showing anterior and posterior horns, with caudothalamic notch imaged if possible
  • through each hemisphere lateral to the ventricle for deep white matter
• Supplemental oblique, surface and axial images may be necessary to record pathology
• For detection of cerebellar lesions, scanning through posterior fontanelle (junction of lambdoid and sagittal sutures) and mastoid fontanelle (junction of posterior parietal, temporal and occipital bones) can be useful

• Must be done by appropriately trained staff 
• Scans must be reported using categories/terminology in Table below
• Consider further imaging e.g. MRI scan or, if ultrasound abnormal, CT scan of brain

• Any member of neonatal team may communicate a normal result to parents but it is vital to give a consistent interpretation. Note that a normal scan does not equate to normal development and follow-up is essential
• Discuss an abnormal result with neonatal consultant before discussion with parents – an abnormal scan does not equate to abnormal development, follow-up is essential

• Documentation is extremely important. Save copies as per unit policy for future review/reference/comparison – each image must contain patient identifiers
• Record following information on investigation chart:
  
  • date scan requested
  • date scan carried out
• Record ultrasound result (or file a written report) in baby’s notes (neonatal staff) 
• Complete cranial ultrasound ad hoc form in BadgerNet 
• Record plan for performing future scans 
• Record in notes any discussion with parents, especially of abnormal scans 
• Include results of all scans in discharge summary, even if normal
• If eligible baby transferred to another hospital before scanning, communicate need for scan in transfer summary