Ultrassonografia craniana no prematuro tardio: o exame deve ser incorporado à rotina do cuidado neonatal?

Abstract

Objective This study aimed to assess the use of cranial ultrasound in routine neonatal care for late preterm infants, in order to determine the prevalence of alterations in cranial ultrasound and to identify the occurrence of risk factors associated to these alterations. Methods Cross-sectional study, with prospective collection, performed in a tertiary maternity, from May 2019 to August 2020. Were included newborns with gestational ages of 34 to 36 weeks and 6 days, without malformations, whose parents signed a Free and Informed Consent Term. Cranial ultrasound was performed during the first week of life and was classified in two different groups: normal or altered. Statistical analysis was performed using IBM SPSS 21 software. Variables with p-values < 0.10 in the univariate analysis were included in a multivariate model. Statistical significance was set at p < 0.05. Results In total,170 cranial ultrasounds were performed; alterations were found in 10% of patients (10%, 11.7% and 8.3% at 34, 35, and 36 weeks, respectively, which were not statistically significant; p = 0.831), with the following cranial ultrasound findings: 3.5% grade I peri-intraventricular hemorrhage, 1.8% periventricular hyperechogenicity, 1.2% lenticulostriate vasculopathy, and 3.5% minor alterations. Univariate analysis demonstrated that early umbilical cord clamping (OR 7.9, p=0.004), need for resuscitation (OR 5.9, p=0.012), surfactant use (OR 5.8, p=0.026), volume expansion (OR 5.8, p=0.026), and presence of neonatal sepsis (OR 3.4, p=0.043), were factors associated with alterations in cranial ultrasonography in the first week of life. Conclusion Cranial ultrasound should be performed in late preterm infants whenever possible. If unavailable for all, late preterm neonates who present clinical risk factors for alterations in ultrasonography should have this exam performed.