Trans-gland ultrasound is a safe, easily repeatable and, above all, cheap examination of newborns and premature babies to assess their central nervous system. It is not painful in any way, but may cause discomfort for the patient. It is performed by a specialist in neonatology, pediatrician or radiologist.

Trans-epithelial ultrasoundis best done early in life - the fontanelles are then unconsolidated and provide a good acoustic window.

The test is usually performed through the front fontanelle, which is available as an acoustic window for the first year of a child's life. It grows over only around nine months of age, and it completely closes around 15 months of age.

It is worth remembering that the reduction of the fontanel with age causes the deterioration of the quality of the obtained images.

There are, however, some clinical situations in which the fontanelle remains unconsolidated. This can occur in premature babies, children with increased intracranial pressure, hydrocephalus, chromosomal changes (trisomes of chromosomes 13, 18 and 21), hypothyroidism and bone diseases (rickets, osteogenesis imperfecta, hypophosphatemia).

Alternatively, the examination can be performed through the posterior and mastoid fontanelles.

Throat ultrasound: indications

Trans-epithelial ultrasound is used to detect bleeding foci, ischemic lesions, cystic lesions, developmental abnormalities, calcifications and birth defects within the central nervous system.

It is extremely important for premature babies and newborns - it is a screening test for intracranial bleeding - intracerebral, periventricular and intraventricular.

It is also used to control infants after bleeding into the central nervous system.

Throat ultrasound: test time

Ultrasound examination performed right after the birth of the baby shows prenatal damage.

Interestingly, bleeding in the central nervous system usually occurs in the perinatal period or in the first days after delivery.

It is worth mentioning at this point that hemorrhagic changes are visible in the examination after only a fewhours since its inception.

The situation is different in the case of ischemic lesions. More time is needed for them to become visible on ultrasound - even several weeks.

In a situation where the test is performed at an inappropriate time, the first signs of ischemic damage to the central nervous system may be elusive on the examination, while the features of mild or severe diffuse damage may be overlooked.

Throat ultrasound: the course of the examination

Transient ultrasound is performed with the use of appropriate probes. A 7.5 MHz probe is indicated for the evaluation of the brain of premature infants. On the other hand, in full-term newborns, older or larger infants, due to the possibility of fontanel overgrowth, a 5 MHz probe is used.

When examining the anterior fontanel, images are obtained in two planes - sagittal and frontal.

Images in the sagittal plane are obtained by applying the probe longitudinally to the fontanel and by inclining the ultrasound beam from the midline in the lateral direction.

On the other hand, images in the frontal plane are created when the probe is applied transversely to the fontanel and the ultrasound beam is tilted from front to back.

It is worth mentioning at this point that a standard trans-gland ultrasound examination should contain 5 sagittal and 5 frontal sections with additional imaging of the brain surface and any detected abnormality.

Compared to the anterior fontanel examination, performing a transverse examination through the posterior and mastoid fontanelles enables a more accurate assessment of the occipital horns of the lateral ventricles, brain tissues in this area, and structures in the posterior fossa of the skull.

Sometimes a transient ultrasound is performed using the so-called temporal window. In this projection, the vessels of the Willis brain circle are assessed. However, it should be borne in mind that the quality of the examination in the temporal window largely depends on the thickness of the skull bone.

The use of pulsed and color-coded Doppler in the study allows the assessment of the anatomy of the cerebral vessels, assessment of cerebral flow and the presence of congenital vascular anomalies.

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