Role of Cranial Neurosonogram in Detecting and Grading Germinal Matrix Hemorrhage in Preterm Neonates: A Cross-Sectional Observational Study

Abstract

Background:
Germinal matrix hemorrhage (GMH) is a common and serious neurological complication in preterm neonates, particularly those born before 32 weeks of gestation. Accurate and timely detection is critical for guiding prognosis and intervention. Cranial neurosonography offers a practical, bedside imaging modality to detect and grade GMH in high-risk neonates.

Objective:
To evaluate the role of cranial neurosonogram in detecting and grading GMH in preterm neonates, assess its association with clinical parameters, and describe characteristic sonographic features across imaging planes.

Materials and methods:

This cross-sectional observational study was conducted in the NICU of a tertiary care hospital in VMKV Medical College , Salem , Tamilnadu, . over a period of  January 2023 to March  2025. A total of 48 preterm neonates (<37 weeks gestational age) underwent cranial ultrasound within the first 7 days of life. GMH was graded using the Papile classification. Clinical variables such as gestational age, birth weight, Apgar scores, mode of delivery, mechanical ventilation, and NICU stay were recorded. Data were analyzed using descriptive statistics and chi-square tests to assess associations between GMH severity and clinical parameters.

Results:
Of the 48 neonates studied, GMH was identified in all cases: 33.3% had Grade I, 29.2% Grade II, 20.8% Grade III, and 16.7% Grade IV hemorrhage. Severe GMH (Grades III–IV) was significantly associated with lower gestational age (p = 0.01), lower birth weight (p = 0.02), lower Apgar scores at 1 minute (p = 0.008), and increased need for mechanical ventilation (p = 0.001). Sonographic detection of hemorrhages varied by grade, with deeper imaging planes (transthalamic, transcerebellar) required for visualization of higher-grade GMH.

Conclusion:
Cranial neurosonography is an effective, non-invasive tool for early detection and grading of GMH in preterm neonates. Its diagnostic value is enhanced through multi-plane scanning and correlates significantly with clinical risk factors. Integrating routine neurosonography in NICU protocols can aid in timely diagnosis, risk stratification, and management planning.