NEUROSONOGRAPHIC IMAGING OF SMALL-FOR-GESTATIONAL-AGE NEONATES EXPOSED AND NOT EXPOSED TO COCAINE AND CYTOMEGALOVIRUS

We sought to prospectively identify the role of neurosonography in the evaluation of a consecutive group of small-for-gestational-age (SGA) neonates, and also to identify the association of neurosonographic fin dings with cocaine exposure and cytomegalovirus (CMV) infection. Neuro sonographic imaging was performed in 180 SGA neonates within 72 hours of birth. Urine samples were screened for CMV and cocaine metabolites (CM) in all cases. Sixty-five neonates (37.5%) had an abnormal neuroso nographic appearance. Nine neonates were positive for CMV and 31 neona tes were positive for CM. Focal echolucencies (27), ventricular dilati on (27), and subependymal hemorrhages (12) were the most common neuros onographic abnormalities. The first two were more common with CM (p <. 05). An abnormal neurosonographic pattern was seen more often in SGA n eonates with CM (54.8%, 17 of 31; p <.05) and CMV (67%, 6 of 9; p < .0 1) as compared with the rest (32.6%, 44 of 135; p <.01). Among those w ithout CM or CMV, prematurity was associated with an increased risk fo r abnormality (p <.001 between groups), specifically subependymal hemo rrhage, ventricular dilation, and porencephalic cysts. Five CMV-positi ve neonates showed periventricular, echogenic foci mainly in the area of the frontal horn. Two new findings with SGA were caudate nucleus ec hogenicity and a ''moth-eaten'' appearance of the thalamus, each found in three infants. Neurosonographic imaging is useful in the evaluatio n of SGA neonates. Focal echolucencies and caudate echogenicity sugges t maternal cocaine use, and periventricular echogenic foci strongly su ggest fetal CMV infection. (C) 1994 John Wiley and Sons, Inc.