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Head ultrasound scans on babies in the Neonatal Critical Care Unit

What is a head u20190131_MMH_40417_edit-(1).jpgltrasound scan?

A head ultrasound is a scan through baby’s fontanelle (soft spot in baby’s skull) to examine the structures of the brain. It is safe and similar to an ultrasound that mothers have during pregnancy; it does not expose your baby to any radiation. 

Why does my baby need a head ultrasound scan?

Preterm babies have an increased risk of changes within the brain and nearby structures. Therefore, Mater’s Neonatal Critical Care Unit (NCCU) performs head ultrasound scans on all preterm babies born at less than 32 weeks gestation and all small babies born weighing less than 1500 g. This scan is done within the first week then repeated at around 28 days of age. Babies weighing less than 1000 g or born at less than 28 weeks gestation will receive a third scan when they reach 34–36 weeks corrected age.

Additionally, all babies (regardless of birthweight or age) needing to be on a breathing machine (ventilator) for more than 48 hours will receive one scan in the first week.

Sometimes a baby has a head ultrasound for another reason and your baby’s doctor will explain this to you.

Why is a head ultrasound scan performed?

For preterm babies the early scans are done to check for bleeding in the fluid spaces (ventricles) of the brain. Your preterm baby’s blood vessels in the middle part of the brain are very fragile and are prone to bleeding.

If bleeding occurs that leaks into the fluid spaces (ventricles) inside and around your baby’s brain, it is called an intraventricular haemorrhage (IVH). The lining of the ventricles makes the fluid that bathes the brain and spinal cord.

The later scans are also looking for a specific brain injury called periventricular leukomalacia or PVL—Peri (around) Ventricular (ventricles are fluid filled spaces in middle of the brain) Leuco (white matter) malacia (softening)—is where injury to baby’s brain may lead to small holes developing within the white matter (tracts of nerve fibres travelling through brain to send messages to muscles) around the ventricles.

How is a head ultrasound scan performed?

The ultrasound is conducted at your baby’s cot side and you are very welcome to stay with your baby during the scan. The radiographer or medical staff doing the scan will wash their hands thoroughly before and after the procedure. The ultrasound probe that is placed on your baby’s skin over the fontanelle (soft spot) is also disinfected.

To ensure that your baby is comfortable during the scan, they will be given (with your consent) either sucrose orally (sugar solution to help with mild pain) or a pacifier (dummy) as sucking can also provide comfort.

A head ultrasound will usually last 10–15 minutes. Because your baby may still be fragile with handling, nursing staff will observe your baby closely. If there are concerns the procedure will be paused.

How long does it take to get the result of a head ultrasound scan?

Your doctor will discuss the results with you on the same day, or the next day, depending on when the report is available (looked at by a specialist in head ultrasounds).

What are some head ultrasound scan results that I may be told about?

Bleeding within the fluid filled spaces (IVH) can be mild to moderate (Grade 1–2) or severe (Grade 3–4).

  • Grade 1 bleed – a small amount of bleeding limited to the lining of the ventricles.
  • Grade 2 bleed – there is slightly more blood that leaks into the ventricle (fluid filled space) and mixes with the normally clear fluid, but the ventricles are not filled with blood.
  • Grade 3 bleed – indicates there is more blood within the ventricles and the ventricles have become swollen (distended) or enlarged.
  • Grade 4 bleed – is similar to grade 3 except the bleeding also affects the brain tissue surrounding the ventricles.

PVL is uncommon and usually doesn’t show up until the head ultrasound scan at 28 days of age or later – PVL is described depending on how much of the brain is involved and whether it affects one side of the brain or both.

What are the chances my baby will have one of these results?

Babies that are smaller and less mature are more at risk. However, most babies have a normal scan result or mild to moderate bleeding. A severe bleed will occur in approximately:

  • 30% of babies born at 23 week
  • 11% of babies born at 24–25 weeks
  • 6% of babies born at 26–27 weeks
  • 2% of babies born at 28–29 weeks
  • 2 % of babies born at 30-31 weeks.

What do these results mean for my baby?

All babies born very preterm have some risk of problems with their learning and development. It is important to know that your baby may still develop problems later on even with a normal head ultrasound. Some ultrasound results make the risk higher, and other results don’t affect the risk much.

In preterm babies, many of the disabilities are mild and treatment or support to help the baby is available. Most babies with Grade 1 or 2 IVH will have normal development, or only mild problems. With severe IVH there is an increased risk of developing long term problems as your baby develops; however, not all babies with severe IVH will develop problems.

These problems can include intellectual disability (difficulties with learning and communicating), cerebral palsy (difficulties with moving), behavioural problems or some combination of these. Occasionally, a baby will have visual deficits (blindness) or hearing problems, but these are fairly uncommon. The risk of these problems is higher in the smallest and most preterm babies, and in those who have severe IVH (grade 3 and 4) or severe PVL.

With bleeding grade 2 or higher, there is some risk that the blood will block up the normal flow of fluid around the brain and this can lead to a build-up of fluid. Most commonly, this gets better without any treatment, but sometimes it leads to the need for an operation to relieve the pressure. If there is bleeding on the first scan, extra scans may be organised to check for this fluid build-up.

Your doctor and nurse will talk in more detail with you about what your baby’s ultrasound result means for your baby and answer any questions you may have.

Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-430217
Last modified 03/4/2019.
Consumers were consulted in the development of this patient information.
Last consumer engagement date: 18/8/2018
For further translated health information, you can visit healthtranslations.vic.gov.au/ supported by the Victorian Department of Health and Human Services that offers a range of patient information in multiple languages.
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