Interobserver variability in assessment of cranial ultrasound in very preterm infants.

BACKGROUND: Cranial ultrasound (cUS) findings help doctors in the clinical management of preterm infants and in their discussion with parents regarding prediction of outcome. cUS is often used as outcome measure in clinical research studies. Accurate cUS performance and interpretation is therefore required. AIMS: The aims of this study were (i) to assess the interobserver variability in cUS interpretation, and (ii) to evaluate whether level of cUS expertise influences the interobserver variability. METHODS: Fifty-eight cUS image series of preterm infants born below 32 weeks of gestation collected within the Swiss Neonatal Network were sent to 27 observers for reviewing. Observers were grouped into radiologists, experienced neonatologists and less experienced neonatologists. Agreement between observers was calculated using Kappa statistics. RESULTS: When cystic periventricular leukomalacia, intraventricular haemorrhage and periventricular haemorrhagic infarction were combined to one outcome, agreement among all observers was moderate. When divided into subgroups, kappa for the combined outcome was 0.7 for experienced neonatologists, 0.67 for radiologists and 0.53 for inexperienced neonatologists. Marked difference in interobserver agreement between experienced neonatologists and radiologists could be found for haemorrhagic periventricular ifraction (HPI). CONCLUSIONS: Our results suggest that interobserver agreement for interpretation of cUS varies from poor to good varying with the type of abnormality and level of expertise, suggesting that widespread structured training should be made available to improve the performance and interpretation of cUS.

Cranial ultrasound findings in well newborn Ugandan infants.

BACKGROUND: There has been no study assessing cranial ultrasound (cUS) scans in newborn infants born in equatorial Africa. OBJECTIVE: To assess the cUS scans of apparently well newborn term Ugandan infants and to correlate the findings with perinatal data. METHODS: An observational study of apparently healthy postnatal ward term Ugandan infants at Mulago Hospital, Makerere University Hospital, Kampala, Uganda. RESULTS: Data from 112 infants scanned at a median age of 1.4 postnatal days were analysed. Only 57 (51%) infants had scans considered normal, including 30 infants with isolated focal peritrigonal white matter (WM) echogenicity that was very common, occurring in 60 (53%) of infants. More extensive WM echogencities were seen in nine (7.5%) and focal unilateral central grey matter echogenicity in eight (6.5%) infants. Haemorrhage was not common. Subependymal pseudocysts (SEP) and choroid plexus cysts (CPC) occurred in 19.6% of infants each. Four infants only had lenticulostriate vasculopathy. No correlation was found between mode of delivery, birth weight, head circumference or gestational age, maternal HIV status and any cUS abnormality. CONCLUSIONS: Apparently well term-born Ugandan infants frequently have abnormalities on cUS. These are mainly increased WM echogenicity, SEP and CPC. These may relate to the reported high incidence of congenital infections in this population but this remains to be confirmed. The observations provide baseline data for comparison with scans from sick infants from similar communities and are also important for studies in which cUS will be used to assess progress.