CRANIAL ULTRASOUNDS

Cranial ultrasound examinations should be obtained on all preterm infants <30 weeks gestation (or <1500 grams) or on any extremely sick infant requiring ventilatory support. First examination should be at 5-7 days; if this exam is abnormal, a repeat exam should be done at age 14 days. Infants <30 weeks gestation (or <1500 grams) or extremely sick infants requiring ventilatory support should have a repeat cranial ultrasound at age 4-6 weeks to evaluate for posthemorrhagic hydrocephalus and/or periventricular leukomalacia. Infants <28 weeks should have a final US at discharge to rule out PVL (this could possibly be their 4th US) since their 4-6 week US may have been done a month or more prior to discharge and PVL may then be apparent.

 Age at time of Ultrasound

 Reason for Ultrasound
 5-7 days  Initial
 14 days  Only if initial US is abnormal
 4-6 weeks (or DC if before 4-6 wks)  Screen for PVL or post-hemorrhagic hydrocephalus
 Discharge (if <28 weeks GA)  Screen for PVL

Routine cranial ultrasounds are ordered for Monday, Wednesday or Friday.

 BAER (BRAINSTEM AUDITORY EVOKED RESPONSE)

Brainstem auditory evoked response is an electrical evaluation of the auditory pathway, from cranial nerve VIII to the midbrain. BAERs are done every Monday and are scheduled by the service coordinator following a written order. They should be ordered far enough ahead of time so that an infant can be tested prior to discharge. However, BAERs are not done before 34 weeks postconceptional age.

The following infants should have BAERs:
  1. Family history of congenital or delayed onset childhood sensorineural impairment.
  2. Congenital perinatal infection known or suspected to be associated with sensorineural hearing impairment, such as TORCH.
  3. Craniofacial anomalies, including morphologic abnormalities of the pinna and ear canal, absent philtrum, low hairline, etc.
  4. Birth weight <1500 grams or <30 weeks gestational age
  5. Serum bilirubin exceeding 25 mg%.
  6. Bacterial or documented viral meningitis or sepsis.
  7. Severe depression at birth (neonates who have Apgar scores <6 at five minutes or who fail to initiate spontaneous respirations by ten minutes of age or those with hypotonia persisting to two hours of age).
  8. Grade IV intracranial hemorrhage or periventricular leukomalacia (on discharge ultrasound).
  9. Abnormally high gentamicin levels.
  10. Mechanical ventilation for a duration equal to or greater than 4 days.
  11. Stigmata or other findings associated with a syndrome known to include sensorineural hearing loss (e.g., Trisomy 21, Waardenburg or Usher's Syndrome).
  12. Shock/hypotension requiring 3 or more colloid boluses or treatment with pressors

 LUNG PROFILE

A lung profile evaluates resistance to expiratory flow, functional residual capacity, and basic lung mechanics (static lung compliance and resistance). These measurements are indices of pulmonary reserve and may be predictive of pulmonary morbidity in infants with chronic lung disease. Infants who had any of the following problems or received any of the following treatment modalities should be considered candidates for a lung profile at the Attending's discretion. It should be scheduled during the week preceding discharge:

  1. At least one week of diuretics for pulmonary disease
  2. High frequency oscillation or jet ventilation
  3. Congenital diaphragmatic hernia
  4. Meconium aspiration syndrome requiring mechanical ventilation
  5. Documented RSV infection requiring mechanical ventilation

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