Survey on the use of Cranial Ultrasound in Neonatal Encephalopathy
An NNCC-SIG Survey- June 2020
William Sanislow1,4, Elizabeth Singh1, MSN, RN, CPNP, Edward Yang2,3, MD, Terrie Inder1,2, MD, MBChB, Mohamed El-Dib1,2, MD
1Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, 2Harvard Medical School, Boston, MA, 3Boston Children’s Hospital, Boston, MA,4University of Michigan, Ann Arbor, MI
There is limited knowledge of the specific differences in therapeutic hypothermia (TH) practices between cooling centers, especially regarding if and how they use neuroimaging. Last year, we created a survey to investigate the current use of cranial ultrasound (CUS) in infants undergoing therapeutic hypothermia. It was sent to the members of the Neonatal Neurocritical Care Special Interest Group (www.NNCC-SIG.org), which consists of neonatologists, neurologists, and radiologists from countries around the world.
We found that there is in fact a wide variation of the use of cUS in TH. Out of a total of 94 respondents whose hospitals offered TH, only 72 (76.6%) of them obtained a cUS at any point during the treatment. Of these hospitals that did obtain a cUS, there were different timepoints that the cUS is performed. Furthermore, when asked whether the cUS results ever lead to the early termination of TH, 3 (4.2%) responded sometimes, 33 (45.8%) responded rarely and 36 (50.0%) responded never. Of the 36 respondents who answered sometimes or rarely, 32 of them indicated the findings that would result in the early termination of cooling, which was largely the presence of intracranial hemorrhage. Of these 32 respondents, 26 specified major intracranial hemorrhage, 1 specified severe diffuse echogenicity in white matter or basal ganglia and thalami, 2 specified brain malformation, and 3 specified severe, near-total brain injury.
The timepoints at which the respondents perform CUS during TH
Results on whether the findings of the CUS would lead to termination of TH
The cranial ultrasound findings that would lead to termination of TH noted by 31 survey respondents