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MINOR CRANIAL ULTRASOUND ABNORMALITIES AT BIRTH AND THEIR RELATIONSHIP TO NEUROBEHAVIORAL OUTCOME: A PROSPECTIVE,

LONGITUDINAL STUDY OF HIGH-RISK NEWBORNS

Matylou Behnke, Fonda Davis Eyler, Cynthia Wilson Garvan, Kathleen Wobie, Michael Conlon, Nanci Stewart Woods, William Cumming

Department of Pediatrics, Box 100296 JHMHC, Gainesville, FL 32610

Minor cranial ultrasound abnormalities have been identilied in about 5% of the newborn population. These abnormalities include such things as mild ventricular enlargement, choroid plexus cysts and subependymal cysts. Although clinicians generally consider these abnormalities to be insigniftcant for the long-term outcome of the term newborn, no convincing data have been published to support this optimism.

Data for this study were collected as part of a prosp&ve, longitudinal maternal-infant health and development study primarily designed to investigate the e&ct that drugs and medications taken during pregnancy as well as different maternal lifestyles, problems that develop during pregnancy, living arrangements, and family caregiving have on the outcome of pregnancy and the growth and development of the child.

Three hundred eight (308) women were enrolled in the project at the time they entered the public health care system either for prenatal care or at delivery if they had no prenatal care. Each subject participated in an in-depth psychosocial interview at the end of each trimester of pregnancy and at delivery. Perinatal risk was determined post- delivery by experienced medical personnel, using the well-published scoring system of Hobel et al. Offspring underwent cranial ultrasound evaluation within 72 hours of birth. All ultrasounds were read by one experienced Pediatric radiologist blinded to any maternal-infant history. The Amiel-Tison Neurologic Assessment and the Brazelton Neonatal Behavioral Assessment Scale were performed within 72 hours of birth by experienced examiners also blinded to medical history.

Of the 308 women originally enrolled in the study, 301 delivered living infants. Of these, 266 infants underwent a cranial ultrasound evahtation. Twenty-seven (27) infants had an ultrasound that was not considered normal. Of these, 6 infants had choroid plexus cysts, 9 had subependymal cysts, 6 had mild increase in ventricular size, 4 had a combination of cysts and increased ventricular size, 1 had a subependymal hemorrhage and increased ventricular size and 1 had subependymal hemorrhage, increased ventricular size, subependymal cysts and calcifications.

The infants with abnormal ultrasounds did not diflii from those with normal ultrasounds on race, maternal parity, a variety of measures of prenatal drug exposure, and the composite scores of the Hobel scale. The groups did, however, differ in socioeconomic status such that infants whose mothers were in the lowest category of the Hollingshead were significantly more likely to have infants with an abnormal ultrasound (12% vs. 4%; p=.O45).

Detailed, blinded neurologic examinations revealed no differences between the infants with normal and abnormal ultrasounds. However, BNBAS evaluations revealed group differences on the Range of State cluster (2.949.76 abnormal vs. 3.3H.62 normal; p=O.OOS) and the Orientation cluster (51722.09 vs. 59521.69; m.0482).

While any abnormality noted on an ultrasound is cause for theoretical concern regarding the outcome of the infant, it appears from these data that the relatively minor abnormalities we observed are not associated with dramatic effects on neurobehavior in the immediate newborn period. Socioeconomic status appears to be a marker, perhaps of lifestyle issues, that does have a significant association with ultrasound abnormalities at birth. Further exploration of these data will include analyses of the neurobehavioral outcome of these infants at several additional time points throughout infancy and early childhood.