Neonatal Neurosonography: Standard Planes, Norms, and Protocol Structure
Indications and Method
Neurosonography (cranial ultrasound) remains a fundamental method for brain imaging in newborns and young children, applicable to both full-term and near-term, as well as preterm patients (Valverde E et al., Dev Med Child Neurol 2025; Horsch S et al., 2024). The examination is conducted transfontanellar, primarily through the anterior fontanelle as the main acoustic window.
Standard Planes
The classic protocol through the anterior fontanelle is based on a series of standardized slices. The exact list and sequence of planes in the provided fragments are not specified [to clarify]; the methodology is detailed in specialized guides (Govaert P, De Vries LS. An atlas of neonatal brain sonography, 2010; Rumack C, Drose J. Neonatal and infant brain imaging, 2011).
In general, the examination includes:
| Plane Group | Purpose |
|---|---|
| Coronal slices | Assessment of hemisphere symmetry, ventricular system, parenchyma [to clarify the list of levels] |
| Sagittal / parasagittal slices | Midline, lateral ventricles, periventricular matter [to clarify the list of levels] |
Evaluated Structures and Norms
The protocol provides for the assessment of the parenchyma, ventricular system, and extra-axial spaces. The size of the ventricles has prognostic significance: a correlation between ventricular width at 1 month and outcomes at 2 years in children under 30 weeks of gestation has been shown (Fox LM et al., 2014). Normal sizes of the intracranial extra-axial compartment in newborns are described using high-resolution sonography (Frankel DA et al., J Ultrasound Med 1998). Specific numerical thresholds in the provided fragments are not specified [to clarify].
Doppler Sonography
Cerebral Doppler sonography in newborns is used as a supplement to grayscale examination for assessing cerebral blood flow; practical guidance on clinical application and diagnosis is presented in Horsch S et al. (Dev Med Child Neurol 2024). Power Doppler is used in pediatric neurosonography (Seibert JJ et al., Radiographics 1998).
Contrast-Enhanced Neurosonography (CEUS)
In contrast-enhanced examination of the newborn brain, a standard pediatric dose of contrast based on body weight is used — 0.03 ml/kg SHLM (AIUM Practice Parameter for CEUS, 2024). The examination is performed with a small convex probe of medium frequency, maintaining cine loops. After contrast administration, visualization is conducted only in low mechanical index (MI), low TI, and low output power mode to avoid microbubble destruction and potential sonoporation; high-energy pulses for 'field clearing' should not be used.
Technology and Documentation
Both 2D and 3D acquisitions of the newborn brain images are possible; the time efficiency and diagnostic agreement of 2D versus 3D have been shown in the study by Romero JM et al. (2014). Documentation of the examination should comply with accepted requirements (AIUM practice parameter for documentation of an ultrasound examination, 2019) adhering to the ALARA principle.
Frequently asked questions
Through which acoustic window is neurosonography performed?
The main window is the anterior fontanelle; the examination is performed transfontanellar. A detailed list of standard planes in the provided sources is not specified [to clarify].
Which structures are necessarily evaluated?
Parenchyma, ventricular system, and extra-axial spaces. Normal sizes of the extra-axial compartment are described by Frankel DA et al. (1998); specific thresholds in the fragments are not detailed [to clarify].
What is the contrast dose for CEUS of the newborn brain?
The standard pediatric dose based on body weight is 0.03 ml/kg SHLM (AIUM, 2024), using a small convex probe of medium frequency and low MI/TI mode.
Is 3D scanning of the newborn brain applicable?
Yes, both 2D and 3D acquisitions are applicable; their comparison in terms of time and diagnostic agreement has been studied (Romero JM et al., 2014).
How is cerebral blood flow assessed?
Using cerebral Doppler sonography as a supplement to grayscale examination; practical guidance is provided by Horsch S et al. (Dev Med Child Neurol 2024). Power Doppler is also used.