CRANIAL ULTRASOUND IN DETECTION OF NEUROLOGICAL LESIONS IN PRETERM NEONATES IN A TERTIARY CARE HOSPITAL – A PROSPECTIVE OBSERVATIONAL STUDY. Badri kumar Gupta Department of Pediatric, Universal College of Medical Sciences, Bhairahawa, Rupandehi, Nepal Original Research Paper Anatomy INTRODUCTION Neonatal sonography of the brain is now an essential part of newborn care, particularly in high risk and unstable premature infants. Cranial ultrasound is the most available and easily repeatable imaging technique for the neonatal brain showing brain development and the most frequently occurring forms of cerebral injury in the preterm and terms. Preterm neonates defined as childbirth occurring at less than 37 completed weeks of gestation. There are three sub-categories of preterm birth based on gestational age: extremely preterm (<28 weeks), very preterm (28 to < 32 weeks) and moderate to late preterm (32 to <37 weeks) (1). Preterm neonates have a higher mortality and morbidity because of their greater risk for intraventricular hemorrhage (IVH) and hypoxic ischemic encephalopathy (HIE) also known as periventricular leukomalacia (PVL), which can lead to poor neurodevelopmental outcomes (2). Hypoxic-ischemic encephalopathy (HIE) is most common clinically encountered problem in neonatal ICU and is significantly associated with neurological demise and cerebral palsy in neonates. Even in developed countries, neonates having moderate to severe hypoxic-ischemic encephalopathy death or moderate to severe disability occurs in 53–61% of infants. In hypoxic-ischemic encephalopathy, neonates brain shows high levels of cerebral blood flow measured at 12–24 hours of life have been associated with more severe brain injury. (3).Intraventricular hemorrhage occurs in 40% of preterm neonates who weigh less than 1500g, 90% of hemorrhages occur within first 3 postnatal days and the remainder by 10 days. However, Intraventricular hemorrhage is usually clinically occult and detection requires a screening USG.(4).Germinal matrix hemorrhage (GMH) is the most common cerebral insult that affects the premature infant. GMH occurs in the germinal matrix which is densely vascular and present at the caudothalamic groove until 35-36 weeks gestation. Therefore the risk of hemorrhage is markedly reduced in infant older than 36 weeks. Infants at greatest risk for GMH are less than 32 weeks gestation, and the risk increases with extent of prematurity (5). The grading system for GMH on NSG is given by Papile et al., 1978 to assess prognosis. Grade I: Subependymal hemorrhage, Grade II: Intraventricular hemorrhage (IVH) without ventricular dilatation, Grade III: IVH with ventricular dilatation and Grade IV: IVH with intraparenchymal hemorrhage (6).Pageeriventricularleukomalacia is the second most frequent lesion of the infant brain, following haemorrhage into the germinal matrix or ventricle. PVL is now considered the principal form of brain injury among preterm infants. PVL is the major reason for developing a variety of neurological sequelae including motor dysfunction, delayed cognitive development, visual impairment and epilepsy seen in 3% to 10% of premature neonates. Early identification may facilitate future preventive strategies. In the recent years, the incidence of all grades of hemorrhage has decreased because of increased antenatal steroid use and improved neonatal care. As cost containment has become a more pressing issue, the need for and frequency of screening USG has been raised (4). The advantages of sonography over CT and MRI include easy to operate, non invasiveness, accuracy, portability, lower cost, rapid diagnosis, wide availability, repeatability, lack of ionizing radiation, no need for sedation, bed side availability for unstable infants and suitable for screening (7). MATERIAL AND METHODS This hospital based prospective observational crosssectional study was conducted in Neonatal Intensive Care Unit department of pediatrics in Universal College of Medical Sciences ,a tertiary care hospital over a period of 1 year,from may2019 to may2020. Other neonates were excluded from study according to exclusion criteria.A total Sixty high-risk neonates admitted to NICU were selected as per the inclusion criteria on nonrandomized purposive sampling basis and BACKGROUND: Incomplete formation and maturation of the central nervous system makes it extremely vulnerable to injury, in the case of premature neonates. This can result in a broad range of neurodevelopmental abnormalities. Cranial ultrasound is a sensitive tool for the early detection of these.Preterm neonates, defined as childbirth occurring at less than 37 completed weeks of gestation, is a major determinant of neonatal mortality and morbidity because of their greater risk for intraventricular hemorrhage (IVH) and hypoxic ischemic encephalopathy (HIE). The morbidity associated with preterm birth often extends to later life, resulting in enormous physical, psychological and economic costs. Currently, many imaging modalities are available like Cranial Ultrasonography, Computed Tomography and Magnetic Resonance Imaging to detect the intracranial abnormalities in these neonates. However advantages of Cranial Ultrasonography are easy availability, not expensive, easy to perform, quick, can be done at bedside, repeatable and radiation free. The aims of the study were to identify the severity of brain injuries by grading the neurosonographic findings and to correlate the clinical presentations with the neurosonographic findings. This study is done in Department of pediatrics in Neonatal Intensive Care Unit MATERIALS AND METHODS: in Universal College of Medical Sciences ,a tertiary care hospital, Bhairahawa. This cross-sectional study comprise of 60 preterm neonates, referred to Department of Radio diagnosis for cranial ultrasonogram. Ultrasound examination of the neonatal brain done through anterior fontanelle in coronal and sagittal planes within 1st week using healthcare logiq p6 pro ultrasound machine. In this cross-sectional RESULTS: study of 60 neonates, 46 were male and 14 were female. Among 60 babies, 30 (50%) showed normal study and remaining 30 (50%) showed abnormal scan. Among the cases which were abnormal on scan most common finding was GMH (33.3%) and next commonest was periventricular leucomalacia (PVL- 16.7%) noted in 10 babies. Cranial ultrasonography is the best point of care neuroimaging CONCLUSION: method available for high-risk neonates. It is critical as an investigatory modality in NICU and effectively documents morphology of cerebral damage. ABSTRACT INDIAN JOURNAL OF APPLIED RESEARCH 23 Volume - 10 | Issue - 11 | November - 2020 | . PRINT ISSN No 2249 - 555X | DOI : 10.36106/ijar KEYWORDS : Cranial Ultrasonography, Hypoxic Ischemic Encephalopathy, Germinal Matrix Hemorrhage, Periventricular Leukomalacia, Preterm neonates. Nand kishor Gupta* Department of Anatomy, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, UP, India.*Corresponding Author Prem Yaday Department of Radiology, Universal College of Medical Sciences, Bhairahawa, Rupandehi, Nepal Sadan Mukhi Department of Radiology, Universal College of Medical Sciences, Bhairahawa, Rupandehi, Nepal