Draft Neonatal Head-Normal

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Image Mouse overs: Static: normal sag midline-------mouseover: normal sag midline hl Static: normal ant coronal-------mouseover: normal ant coronal hl Static: normal parasagittal-------mouseover: normal parasagittal hl Static: normal coronal-------mouseover: normal coronal hl Static: normal parasagittal far-------mouseover: normal parasagittal far hl Static: normal coronal mid-------mouseover: normal coronal mid hl Static: linear coronal normal-------mouseover: linear coronal normal hl Static: normal coronal post-------mouseover: normal coronal post hl Static: linear cor surface-------mouseover: linear cor surface colour Static: normal coronal tent-------mouseover: normal coronal tent hl

ULTRASOUND OF THE NEONATAL HEAD - Normal

Hover cursor over images for highlighted anatomy.

            2 columns of images
            [baby-face-sag.gif]                              [baby-face-coronal.gif]
Static:[normal sag midline.jpg]--mouseover:[normal sag midline hl.jpg]    Static:[normal ant coronal.jpg]---mouseover:[normal ant coronal hl.jpg]
Static:[normal parasagittal.jpg]--mouseover:[normal parasagittal hl.jpg]   Static:[normal coronal.jpg]---mouseover:[normal coronal hl.jpg]

Static:[normal parasagittal far.jpg]--mouseover:[normal parasagittal far hl.jpg]    Static:[normal coronal mid.jpg]--mouseover:[normal coronal mid hl.jpg]

Static:[linear coronal normal.jpg]--mouseover:[linear coronal normal hl.jpg]   Static:[normal coronal post.jpg]--mouseover:[normal coronal post hl.jpg]

Static:[linear cor surface.jpg]--mouseover:[linear cor surface colour.jpg]   Static:[normal coronal tent.jpg]--mouseover:[normal coronal tent hl.jpg]
ULTRASOUND OF THE NEONATAL HEAD PROTOCOL


INDICATIONS

 

  • Prematurity:
    • Some people discriminate between the terms preterm and premature.
    • Preterm refers to delivering prior to 37weeks whilst a premature infant is one that has not yet reached the level of fetal development that generally allows life outside the womb.
    • The fine network of vessels (the germinal matrix) on the floor of the anterior horn of the lateral ventricles (the ependyma) are extremely fragile.
    • If there is any hypoxic episode, the reactive increase in blood pressure can result in a haemorrhage of these vessels.
    • Usually assessed at day 1 and again at day 7.
  • Increased head circumference
  • Persisting large fontanelle
  • Craniosynostosis (premature closure of sutures)
  • Trauma
  • Known hypoxia
  • Follow up of known pathology
  • Failure to thrive
  • Suspected intracranial mass or infection



LIMITATIONS

If the anterior fontanel is very small or closed your visibility will be reduced or completely obscured. Even with a large fontanelle, the peripheral extremes of the brain are obscured from view.

EQUIPMENT SELECTION AND TECHNIQUE


Probes:

  • Primarily a small footprint, wide sector, mid.-frequency probe is essential.
  • Ideally a specific 5-8MHz vector probe however a trans-vaginal probe also provides excellent imaging. (A TV probe can be ergonomically difficult to use for some operators and awkward to ft in a humidicrib.)
  • You may also require a high frequency linear array to assess superficial structures and a curvilinear probe for axial trans-temporal images.


Environment:

  • A warm room with warm gel.
  • If still in high oxygen environment, this should be maintained as much as possible.
  • Patient position:
  • If still in a humidicrib as a high oxygen environment, the baby must be scanned there. You may need to place a cloth under and/or beside the baby's head to support and immobilize it for the scan.



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SCANNING TECHNIQUE

 

  • Use sufficient gel to not require too much transducer pressure.
  • Approach is generally via the anterior fontanel. The posterior fontanel can also be used.


  • Using the small footprint sector or TV probe:
    • Begin in a coronal plane slowly sweeping from the anterior to the posterior.
    • Rotate 90o to perform sagittal and para-sagittal views.

  • Using the high frequency linear probe:
    • Gently scan through the anterior fontanelle in transverse.
    • You should assess the superior sagittal sinus for patency, and the sub-arachnoid space.
    • You will usually be able to scan as deep as the 3rd ventricle.

  • Using the 5mHz curvilinear probe: scan through the temple in an axial plane, particularly assessing the opposite subdural region.



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WHAT TO LOOK FOR:
  • A solid grasp of the intracranial anatomy is vital.
  • Also, a thorough understanding of the developmental evolution of the neonatal brain and how it changes between 28weeks and term.
  • Essentially, the normal 10week premature brain is relatively smooth, homogenous & devoid of sulci/gyrae.

 

SAGGITAL

 

  1. Midline (must include corpus callosum the 3rd and 4th ventricles and cerebellum).
  2. Parasagiattal to show caudothalamic notch and detail of lateral venticles
  3. Far lateral to show periventricular white matter.



CORONAL

 

  1. frontal
  2. caudate region
  3. series of images caudate to trigone of lateral ventricles
  4. occipital region



MEASUREMENTS
  • Coronal: frontal horn of lateral ventricles at the foramen of monroe (caudate nucleus)
  • Sagittal: trigone of lateral ventricles

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BASIC HARD COPY IMAGING


A neonatal head series should include sequential images coronally from anterior to posterior and sagittally from midline left and right.

  • Document the normal anatomy. Any pathology found in 2 planes, including measurements and any vascularity.
  •  
     

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