# Ultrasound Evaluation of the Deep Cerebral Venous System in Term and Preterm Neonates: Normal Features and Correlations with the Occurrence of Germinal Matrix/Intraventricular Haemorrhage

## TL;DR

This study uses ultrasound to examine the deep cerebral veins in newborns and finds that certain vein angles may predict the risk of brain bleeding in preterm infants.

## Contribution

The study identifies a correlation between the angle of venous confluence and the occurrence of germinal matrix/intraventricular haemorrhage in preterm neonates.

## Key findings

- The angle at the confluence of the terminal and internal cerebral veins is significantly lower in preterm infants with GM/IVH.
- This angle can predict the risk of GM/IVH with 79% sensitivity and 67% specificity.
- The angle is also lower on the side of the brain where haemorrhage occurs.

## Abstract

Background/Objectives: The variability in the structure of the deep cerebral venous system in neonates is increasingly recognised, as are the vascular structural factors involved in the development of the germinal matrix/intraventricular haemorrhage (GM/IVH) in premature infants. We aimed to characterise the ultrasound patterns of these veins in different categories of newborns and to assess if there is a correlation between certain patterns and angles and the presence of GM/IVH. Methods: One hundred neonates (68 at-term and 32 preterm) were included in this research. The pattern of venous drainage and the angle at the confluence between the terminal vein (TV) and internal cerebral vein (ICV) were identified on coronal sections through the anterior fontanel. The normal pattern was considered as that in which the confluence between the TV and the ICV could be identified, and the atypical pattern was considered the situation in which no confluence or terminal vein was identified. Results: There was no statistically significant difference regarding the normal or atypical venous patterns between the groups (p < 0.443), neither regarding the angles between TV and ICV between term and preterm neonates (p < 0.279—left; p < 0.718—right), and singletons and twins (p < 0.745 left; p < 0.418 right), or between the angles on the left and on the right in the whole group (p < 0.121 and the subgroups of term (p < 0.440) and preterm neonates (p < 0.092). The mean value of the angle at the confluence between the TV and the ICV on the left, was significantly lower in the premature infants with GM/IVH (124.90° vs. 137.02°; p = 0.012), being a good predictor for the occurrence of the lesion (AUC = 0.793; IC 95%: 0.580–1.006; p = 0.018), with a sensitivity of 79%, a specificity of 67%, and a cut-off value of 126.90°. In patients with GM/IVH, the angle was significantly lower on the side with the haemorrhage than on the side without haemorrhage (p < 0.043). Conclusions: There is no difference in the central venous pattern or angle at the confluence of the TV and the ICV between different categories of neonates. The angle at the confluence between the TV and ICV could identify the cases at risk for GM/IVH as well as the side of occurrence of the haemorrhage, offering the opportunity of developing personalised prevention strategies. The lack of an MRI comparator of these measurements limits the practical importance of this study.