NSG brain of newborns: indications for the procedure, transcript. Neurosonography
Ultrasound has reached maximum popularity today; it can be used to diagnose many diseases of internal organs. But the visualization of the internal organs of the possibility of ultrasound is not limited. This type of examination can also be used to study the structure of the brain of a newborn baby and provides ample opportunities for the earliest possible diagnosis of certain pathological conditions, and hence their early correction.
What is neurosonography?
The possibilities of diagnosing various pathological conditions are expanding. Today, at the clinical examination, neurosonography (NSG) is assigned to almost every baby.What is this examination? What questions can the doctor answer by conducting this diagnostic procedure?
The undoubted advantage of this diagnostic technique is its absolute safety for a small patient. NSG (neurosonography) of the brain of newborns is a fairly convenient and informative examination of the brain of children in the first months of life, which is carried out with the help of ultrasound.
Why do neurosonography?
Ultrasound is necessary to detect at an early age structural changes in organs located in the skull. The timely diagnosis of many pathological conditions significantly expands the possibilities for their prompt correction with minimal consequences for a small patient.
Benefits of Neurosonography
- To conduct this survey does not require any special training.
- The examination is non-traumatic and absolutely safe for the child. If re-examination is necessary, the procedure can be performed an unlimited number of times, since the procedure does not affect the general condition or the well-being of a small patient.
- Manipulation does not require immobility; It is possible to inspect both a sleeping and awake child.
- If the child is in the hospital, an ultrasound of the head of the newborn can be carried out without interrupting the main therapeutic measures (for example, in the intensive care unit).
The formed bone tissue does not allow ultrasonic waves to pass through; therefore, it is impossible to examine the brain of an adult using this method.
Brain researchusing ultrasound in children less than one year of age becomes real thanks to certain anatomical features of the skull of a child who has not reached the age of one. Nature seemed to have taken care that during the first year of the infant’s life it was possible to diagnose and correct a number of violations in time, leaving the doctors “loopholes” in the form of fontanels.
Features that allow you to "look" inside the skull of a child
- The large (front) spring is the anterior portion of the parietal region.
- The scales of the temporal bone at this age have a minimum thickness, which allows ultrasound to pass through this structure, allowing for a more detailed examination of newborn children.
- The anterior-lateral spring is located in the temporal region, in front of the auricle.
- The back-side fontanelle, located behind the auricle.
Lateral fontanels occur mainly in preterm infants. In full-term babies, the lateral ventricles are covered with a thin layer of bone tissue, the thickness of which allows free ultrasound.
Who shows neurosonography?
- Newborn babies whose condition requires intensive care or intensive care.
- Babies born prematurely.
- Children born with suspected intrauterine infection.
- Newborns who undergo hypoxia during the prenatal period or during labor.
- Children diagnosed with or suspected of birth injury.
- NSG of the brain of newborns is carried out in all cases when traumatic obstetric benefits have been applied.
- Large newborns, as well as, on the contrary, having insufficient body weight at birth, are mandatory.
- Kids who have any neurological symptoms on examination.
- Children who have an unusual structure of the facial skull, an atypical head shape, disorders or abnormalities of the structure of organs and systems.
- Usually, an ultrasound examination of the brain is recommended to be done at least once for each child — in the maternity hospital or at the age of one month — to exclude pathological changes that may appear much later.
In the course of this study, in addition to the anterior fontanelle, temporal areas, as well as lateral fontanels, are used as an additional access for the review. In addition, if necessary, a large occipital foramen can also be used (access is carried out at the maximum inclination of the baby's head forward).
The duration of the manipulation is small - about 10 minutes. During this period of time, the child lies on the couch, while the mother or the medical worker keeps his head stationary.
Inflicting a special gel on the fontanelles, the doctor applies a sensor to the desired areas, and, observing the dynamically changing image on the display of the device, registers the necessary parameters.
The gel after the completion of the procedure is removed from the skin with an ordinary napkin. Since it is completely neutral, it does not cause any undesirable effects on the baby’s skin.
What can be judged by the results of NSG brain of newborns? This manipulation will not help to identify any functional disorders. Ultrasound examination of the brain recognizes only structural changes in various parts of the brain. Based on the data obtained as a result of this manipulation, the doctor may suspect a particular pathology, diagnose brain developmental defects. Some of them may not appear at all throughout their lives. However, all identified pathologies of the brain structure are subject to mandatory supervision by a specialist.
However, with a number of diseases manifested by pronounced disorders of the hormonal, genetic, biochemical nature, the structural abnormalities of the brain are not observed. In the diagnosis of such pathologies NSH brain of newborns will not help.
What abnormalities can neurosonography reveal?
- Cysts of the vascular plexus.The formation of these bubbles with a liquid does not at all indicate the presence of any pathologies and does not cause pathological symptoms. The appearance of cysts at a certain stage of ontogenesis and their disappearance is further considered to be the norm. The formation of cysts in the choroid plexus may also be a consequence of hemorrhage into the choroid plexus, but in this case they do not require scrupulous observation or serious intervention.
- Subependymal cysts. These are cavities filled with fluid, located in the area of the cerebral ventricles. Such cysts are formed as a result of hemorrhage (in utero or after birth) with localization in this area, as well as ischemia. These formations usually do not show themselves and tend to disappear over time independently. However, it is recommended to observe them, since their cause is a pathology of the blood supply.
- Arachnoid cysts. A frequent finding in the NSG brain of newborns. They represent an abnormal development of the arachnoid membrane of the brain. The location, shape and size of such cysts can be very diverse.These formations require mandatory observation by a neurologist and ultrasound monitoring. Arachnoid cysts do not disappear with time.
- Intracranial hypertension. Suspicion of this pathology is one of the most frequent indications for ultrasound of the head of a newborn. The reason for the development of such a condition can be any intracranial volumetric process, represented by various types of tumors (quite rare in newborns), large-sized cysts or hematomas. However, the majority of cases of hypertensive syndrome in newborns are cases of an excess of cerebrospinal fluid in the ventricles of the brain. A number of causes, such as inflammatory processes, malformations, or hemorrhages previously transferred, cause a sharp increase in the volume of cerebrospinal fluid and expansion of the liquor spaces. This condition is called hydrocephalus. If neurosonography detects hydrocephalus, the examination should be repeated after a month, after which it is necessary to consult with a neurologist. Hydrocephalus found in NSG does not always manifest itself by anysymptoms; and vice versa: the clinically manifested expansion of the cerebrospinal fluid spaces may not have ultrasound evidence.
- Intraventricular hemorrhage. These are hemorrhages localized in the ventricles of the brain; This condition is typical for babies born prematurely, especially before the 34th week of pregnancy. In terms of the accuracy of diagnosing this pathology, neurosonography is significantly superior to computed tomography. That is why prematurity is an indication for mandatory neurosonography.
- Parenchymal hemorrhage. In most cases, occurs in the first day of the life of the newborn, but it can also develop in utero. This pathological condition is one of the consequences of the inflammatory process in the brain, and in addition, it develops in birth trauma, disturbances in the blood coagulation system (often accompanied by severe hemolytic disease of the newborn), and severe acute hypoxia. In the future, this condition can cause serious disorders and requires adequate treatment, especially in the first year of a child’s life.
- Hemorrhages with localization in the region of the meninges. This group of hemorrhages includes subarachnoid, epidural and subdural. Subarachnoid hemorrhage is the most common finding. However, with sufficient certainty it is possible to diagnose only large hemorrhages. Small subarachnoid hemorrhages can resolve without consequences, without causing changes in the general condition of the child. Subdural and epidural intracranial hemorrhages are consequences of serious birth injuries.
- Ischemic brain lesions are distinguishable in NSG. What are these states? This deviation is a consequence of hypoxia of the newborn, and the degree of its severity is directly proportional to the severity of the transferred hypoxia. Neurosonography, conducted in the first days of life, does not answer the question about the outcome of the defeat. Therefore, to clarify the forecast, it is necessary to repeat the ultrasound examination of the brain upon reaching the age of 1-2 months. Fortunately, such a re-examination often reveals no pathological foci.However, death of whole sections of nervous tissue with the formation of softening foci is also encountered.
- Malformations of the brain. This is another group of disorders that are visualized using neurosonography. Some of these disorders may not manifest themselves throughout a person’s life. However, all such violations are subject to observation by a neurologist.
How is neurosonography deciphered?
The norm is the symmetry of the cerebral ventricles pattern and the absence of their expansion; the clarity of the contours of all structures of the brain, the absence of tumors. In the case of registration of very large deviations from the norm, it is strongly recommended to repeat the examination in order to eliminate the technical failure of the ultrasound apparatus, as well as the human factor during the NSG. Decoding is carried out by the doctor of functional diagnostics; moreover, deviations within a few millimeters specified in the protocol of examination of the brain may be the results of measurement errors.
Are there any contraindications for neurosonography?
Ultrasound examination of the brain is a completely non-traumatic method of diagnosis that does not affect the general condition of the child and does not change his health.Therefore, there are no contraindications for this procedure.