As the rate of preterm births continues to rise, a thorough neurological examination of newborns born too soon is more crucial than ever. As a result of advancements in NICU technology, the survival rate of babies with extremely low birth weight has also increased. There is a higher chance of neurological abnormalities occurring in the survivors. Premature infants have an increased risk of developing neurological impairments, and about 10% of these infants will go on to have substantial learning problems, motor developmental disabilities, cerebral palsy, seizures, or mental retardation. White matter injury, germinal matrix haemorrhage, intraventricular haemorrhage, periventricular leucomalacia, cerebellar haemorrhage and atrophy, and periventricular leucomalacia are all examples of brain injuries that may develop from secondary hemodynamic disturbances. Timely detection of intracranial abnormalities is critical for improving neonates' health and lowering their risk of death or disability later on.
Top1. Introduction
The first attempt at sonography of the head was made in 1955, and it used the utilisation of Amode to detect midline structure and obtain a rough estimate of ventricular size. It wasn't until 1963 that the two-dimensional bidirectional echoencephalogram was developed (Back & Rivkees, 2004). This was a significant technical achievement because it improved the information that could be gathered on ventricular size as well as the spatial relationships inside the brain (Bowie et al., 1983). Two-dimensional imaging of the baby skull became possible with the development of the Octoson and sector-format real-time ultrasonic sensors.
Resolution and picture display are comparable to what can be achieved with computerised tomography and even appear to be higher in some instances. Because neonatal brains have a higher proportion of water than adult brains do, CT is not the modality of choice because it cannot differentiate between grey and white matter as effectively. In most cases, computed tomography (CT) and magnetic resonance imaging (MRI) are being phased out in favour of ultrasonography because to its portability, low cost, absence of ionising radiation, quick examination periods, and absence of the requirement for sedation. In 1980, it was advised that sonography be used as the primary method for detecting cerebral bleeding in premature infants (McGuinness & Smith, 1984).
This method detects subependymal germinal matrix haemorrhage, intraventricular haemorrhage, and ventniculomegaly with a high level of sensitivity while maintaining a high level of specificity. Studies that are satisfactory can be carried out at the bedside of the infant with very little danger to the child. In order to investigate the frequency of subependymal germinal matrix haemorrhage as well as its sonographic appearance, a prospective study involving 25 consecutive premature newborns weighing less than 1,500 grammes was carried out (Leksee, 1956). The haemorrhage was originally observed in the region that is directly anterior to the caudothalamic groove in each and every one of the 12 cases in whom the sonography was positive. It is important to pay particular attention to this region since doing so enables the early detection of germinal matrix bleeding (London et al., 1980).
Neurosonography of neonates should be regarded as incomplete until this region has been scanned in its whole. 112 neonates who were born one after the other and with birth weights ranging from 1,551 to 2,000 grammes were subjected to cerebral ultrasonography screening for the duration of a research project that lasted for fourteen months (DeVlieger and Ridder, 1959). Nineteen patients, or seventeen percent, had scans that were abnormal (Rumack & Drose, 2011). There were 14 germinal matrix haemorrhages and/or intraventricular haemorrhages among these anomalies, which accounts for 13 percent of the total (Volpe, 1995). More over fifty percent of the haemorrhages that were found were severe, meaning that they were grades III and IV. Over the course of nine months, 96 newborns weighing less than 1500 grammes each had a neurosonogram conducted on them (Singh et al., 2007). Twenty-two of the infants, which is twenty-three percent of the total, experienced intracranial subependymal or intraventricular haemorrhage. 13 of these patients, or 59 percent, experienced ventricular enlargement as a result of the haemorrhage. In 77 percent of the instances, this enlargement occurred within two weeks of the haemorrhage.
1.1. Brain Anatomy
The brain is separated from the rest of the body by the skull, which contains the cranial cavity. The foramen magnum connects the brain to the spinal cord. From the outside in, it is protected by three distinct layers of meninges, which are referred to as the dura matter, the arachnoid matter, and the pia matter. The forebrain, the midbrain, the hindbrain, and the spinal cord make up the three major divisions that may be found in the human brain (Govaert and DeVries, 2010). The diencephalon and the cerebrum make up the forebrain (Martin et al., 2002). The diencephalon is located in the middle of the forebrain. The medulla oblongata, the pons, and the cerebellum are the three major components that make up the hind brain (Skullerud and Wester, 1986).