Cranial sonography in very-low-birth-weight infants: do all infants need to be screened?

The objective of the study was to develop clinical screening criteria to diagnose infants with intraventricular hemorrhage (IVH) and cystic periventricular leukomalacia (PVL). We performed a case-control investigation of two cohorts of very-low-birth-weight infants (n = 505, combined cohorts). Univariate and multivariate analyses were performed from data obtained in cohort 1 to develop screening criteria for IVH and cystic PVL. The screening criteria were then applied to cohort 2. The screening criteria for IVH had a sensitivity of only 51%, a specificity of 62%, a positive predictive value of 31%, and a negative predictive value of 79%. Screening criteria for cystic PVL had a sensitivity of only 22%, a specificity of 58% a positive predictive value of 2%, and a negative predictive value of 95%. These data suggest that using clinical criteria to determine which infants should receive screening cranial sonography for IVH and cystic PVL would miss a substantial number of infants with these conditions.