Kim Annink

80 Chapter 4 Development of the CUS scoring system The following potential CUS items were found in the literature: slit-like ventricles, impaired differentiation white/grey matter, “four column” sign, hyperechogenicity of the thalamus, putamen, subcortical white matter, periventricular white matter, hippocampus, brainstem and vermis, visibility of the posterior limb internal capsule (PLIC) and RI of a cerebral artery ≤0.55 (17, 22-28, 30). We excluded hyperechogenicity of the hippocampus, vermis and brainstem because these structures were rarely depicted on the available CUS images. The RI was scored based on all available ultrasounds, if the RI was ≤0.55 at one of these CUS, this item was scored as abnormal. The CUS scoring system and neurodevelopmental outcome on day one Antenatally acquired pathology was found in 14 infants (17%). Germinal layer cysts (n=7), lenticulostriate vasculopathy (n=4), frontal horn cysts (n=2) and porencephaly (n=1) were identified. On day one, only severe hyperechogenicity of the periventricular white matter on CUS was significantly associated with adverse outcome (OR=5.0; 95%CI 1.4-18.4) in univariate logistic regression. The other items were not significantly associated with adverse outcome. Although it did not reach significance, all infants with hyperechogenicity of the thalamus (moderate n=5; severe n=1), of the putamen (moderate n=2) or a four column sign (n=1) on day one had an adverse outcome. The CUS scoring system and neurodevelopmental outcome between day three to seven Between day three and seven after birth, most of the CUS items significantly predicted adverse outcome in the univariate logistic regression analysis (Table 3).