The Role of Ultrasound in Early Detection of Hydrocephalus in Preterm Neonates with Emphasis on Doppler Indices. A Prospective Case Control Study

Background: Cranial Ultrasonography (CUS) is a safe, bedside imaging tool commonly used in NICUs to assess the brain of preterm infants. It provides real-time visualization of the ventricles and can detect signs of hydrocephalus. Additionally, Doppler Ultrasound evaluates cerebral blood flow using indices like peak systolic velocity (PSV) and resistive index (RI), which may indicate early changes in cerebral perfusion and intracranial pressure before structural abnormalities appear. Aim: to evaluate the role of Ultrasonography and Doppler indices in the early detection of hydrocephalus changes in preterm neonates. Patients and methods: This is a prospective case control study conducted upon 40 preterm newborns (< 37 weeks), equally divided into two groups: Group A (n = 20) with clinical and/or radiological proof of hydrocephalus, and Group B (n = 20) without evidence of clinical and/or radiological proof of hydrocephalus, with age and sex matched with the formal group. Results: There were insignificant variances among the case and control groups as regards age, gender, mode of delivery, maternal parity, or history of risky pregnancy. A statistically significant higher proportion of very low birthweight infants (<1.5 kg) in the hydrocephalic group (60%) compared to controls (15%). Perinatal and neonatal risk factors were more common among hydrocephalic patients than controls. Cranial Ultrasonography (CUS) revealed Peak systolic velocity (PSV) and RI of the anterior cerebral artery (ACA) and internal carotid artery (ICA) were higher in hydrocephalic group than control group (p< 0.001). Conclusion: Cranial Ultrasound with Doppler is a useful non-invasive tool for early detection of hydrocephalus in preterm neonates. Doppler changes, especially RI in cerebral arteries, aid early identification and intervention.