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ARTICLES: Haim Bassan, Carol B. Benson, Catherine Limperopoulos, Henry A. Feldman, Steven A. Ringer, Elaine Veracruz, Jane E. Stewart, Janet S. Soul, Donald N. DiSalvo, Joseph J. Volpe, and Adré J. du Plessis Ultrasonographic Features and Severity Scoring of Periventricular Hemorrhagic Infarction in Relation to Risk Factors and Outcome Pediatrics 2006; 117: 2111-2118 [Abstract] [Full text] [PDF]

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Do Higher Cranial Ultrasound Severity Scores Really Predict Worse Outcome?

Fattma Abdel-Salam, Ravi S Swamy   (22 June 2006)

Do Higher Cranial Ultrasound Severity Scores Really Predict Worse Outcome? 22 June 2006
Fattma Abdel-Salam, Senior House Officer James Cook University Hospital, Middlesbrough, UK, Ravi S Swamy Send letter to journal: Re: Do Higher Cranial Ultrasound Severity Scores Really Predict Worse Outcome? fattma22{at}hotmail.com Fattma Abdel-Salam, et al.	To the Editor Bassan et al1 have described a clear method of defining territories, categorising and subsequently scoring the extent of brain injury from PVHI which can be easily replicated in other centres. They have also commented on the topography and evolution of PVHI in preterm infants, and have concluded that higher severity scores predict worse outcome. However, the recent EPIPAGE cohort study2 concluded that although severe cranial ultrasound abnormality predicted motor disability, one third of infants with cerebral palsy had no ultrasound abnormalities. In light of this study, we think that concluding higher severity scores predict worse outcome is too broad. We feel that abnormal cranial ultrasound scans cannot be used to guide clinicians regarding management decisions such as the withdrawal of care in neonates. In addition, although the authors provide data on the percentage of infants with abnormal neurological examination at each score and breakdown the specific types of motor abnormality found on examination, it would have been interesting to see if the severity of neurological examination correlated with the highest scores. We suggest that more clinically applicable conclusions would be obtained if a study is done to compare risk factors and outcomes in two different groups; those with suspected PVHI and those with apparently normal cranial ultrasound scans. REFERENCES 1. Haim Bassan, Carol B. Benson, Catherine Limperopoulos et al. Ultrasonographic Features and Severity Scoring of Periventricular Hemorrhagic Infarction in Relation to Risk Factors and Outcome. Pediatrics. 2006; 117: 2111 - 2118. 2. Pierre-Yves Ancel, Florence Livinec, Béatrice Larroque, et al. Cerebral Palsy Among Very Preterm Children in Relation to Gestational Age and Neonatal Ultrasound Abnormalities: The EPIPAGE Cohort Study. Pediatrics. 2006; 117: 828-835. Conflict of Interest: None declared