Kim Annink

85 Cerebral ultrasound scoring system for neonates with HIE developed based on the CUS between day three and seven after birth; the CUS on day one after birth was not predictive of adverse outcome. The CUS scoring system was validated in another cohort and the performance was relatively good. To the best of our knowledge, this is the first CUS scoring system using a validated composite score to predict an adverse outcome. Currently, three CUS scoring systems for infants with HIE are available. A CUS scoring system for asphyxiated infants in Uganda has recently been reported (17). This scoring system was used to identify early HIE-related brain damage but did not provide predictive values (17). Two other scoring systems were developed to score patterns of brain injury in HIE. Leijser et al. scored combinations of white and grey matter involvement and compared CUS and MRI (26). The other CUS scoring system by Swarte et al. defined six different patterns, for example, the combination of deep grey matter involvement and extensive cortical involvement (28). These scoring systems, did not allow different items to be scored within the categories separately. For example, when describing deep grey matter involvement, this may imply that the left and right thalamus are affected but the basal ganglia are not, while it is of importance to distinguish between just thalamic involvement and thalamic and basal ganglia involvement. Furthermore, they combined white and grey matter involvement, even though different types of brain injury might lead to different outcomes (5). For these reasons, we developed a CUS scoring system based on composite scores, which might be easier to use in clinical practice. The composite scores for deep grey matter and white matter involvement had to be summed because of multicollinearity. However, it remains possible to score the different items separately and to make a distinction between white matter and deep grey matter involvement. Additionally, this is the first CUS scoring system in HIE that is validated in another cohort. As expected, all scored items on day three to seven in the univariate analysis were significant predictors of adverse outcome. These items have all been described as asphyxia-related brain injury (19, 23, 25, 26, 30-32). Asphyxia-related brain injury is more common in HIE, but as many as 34.2% of controls also showed periventricular hyperechogenicity and 9.2% slit-like ventricles shortly after birth (22). Further, Eken et al. correlated hyperechogenicity on CUS with histological findings: hyperechogenicity of the thalamus occurred within 72 hours after birth on CUS (sensitivity 100%, specificity 83.3% of CUS compared to histology), hyperechogenicity of the periventricular white matter within 24 hours (sensitivity 100%, specificity 83.3%) and 4