What a Baby's First Day Ultrasound Can Reveal About Brain Health

How New Research on Early Head Scans in Premature Babies Is Reshaping Questions About When Brain Injury Begins

When a baby is born very early, doctors typically wait about one to two weeks before doing the first ultrasound of the brain, because that is when bleeding and other injuries are believed to become fully visible. A new study of 365 premature babies found that scanning the brain on the very first day of life — instead of waiting — already picked up some kind of finding in roughly 4 in 10 babies, and that some of the earliest bleeding looked, on ultrasound, like it may have started before the baby was even born. The findings are considered early and promising, not yet a reason for hospitals to change how or when they scan premature babies.

Premature babies — those born before 37 weeks of pregnancy — are more likely than full-term babies to have some kind of brain injury, most often bleeding inside the brain called intraventricular hemorrhage, or IVH. For years, the standard approach has been to wait before scanning, based on the idea that most of this bleeding happens after birth, as a complication of prematurity. But doctors have increasingly wondered whether some of it might actually begin earlier than that — even before delivery.

A 2026 study from Carmel Medical Center, a newborn intensive care unit in Haifa, Israel, looked at this question directly by scanning 365 premature babies within 24 hours of birth, between 2014 and 2020, and then following each baby's brain scans over time [1].

Why Hospitals Currently Wait to Scan

Today, most hospitals follow guidance that says premature babies born before about 30 weeks should get their first routine brain ultrasound between 7 and 14 days of age. This comes from two sources: an older set of recommendations from 2002 by brain and nerve specialist groups [2], and updated 2020 guidance from the American Academy of Pediatrics (AAP), the main professional group for children's doctors in the United States [3]. The 7-to-14-day window was chosen on purpose — not because nothing happens earlier, but because bleeding inside the brain (IVH) needs time to fully show itself on ultrasound. Scanning too soon, doctors worried, might miss how serious a bleed would eventually become, or miss it altogether before it was visible.

At the same time, doctors who care for babies before birth have been learning more about brain bleeding that can start in the womb — sometimes linked to a womb infection called chorioamnionitis, or to problems with how the placenta (the organ that delivers oxygen and nutrients to the baby before birth) is working [4]. Scientists who study how the preterm brain develops have also come to see brain injury in premature babies as a mix of processes — some that damage tissue directly and some that affect how the brain finishes developing — that can begin before birth, not only after it [5]. This has raised a question: if brain injury can sometimes start before delivery, is a scan that waits a week or two missing the earliest, and possibly most informative, picture? A couple of recent studies have started to look at whether the usual scanning schedule for premature babies still makes sense [6] [7], but no earlier study had directly compared a day-1 scan to the standard, later scan in the same group of babies across the full range of prematurity — which is exactly what this study set out to do.

How the Study Was Done

Researchers at Carmel Medical Center, a tertiary (specialist referral-level) newborn intensive care unit in Haifa, Israel, reviewed the records of 365 babies born prematurely between June 2014 and July 2020, ranging from 24 weeks (extremely early) to just under 37 weeks (later preterm) [1]. The babies were grouped by how early they were born: extremely preterm (24–30 weeks, 69 babies), very preterm (30–34 weeks, 129 babies), and moderate-to-late preterm (34–37 weeks, 167 babies).

Every baby had a head ultrasound within 24 hours of birth, read independently by two newborn specialists, with a third settling any disagreements. Bleeding was graded on a standard 4-level scale (Grade I mildest, Grade IV most severe), and other brain changes were classified using standard categories, including changes to the white matter (WM) — the tissue that carries nerve signals between different parts of the brain.

A key idea in this study is "clot liquefaction" — a specific look that a blood clot takes on ultrasound as it starts to break down, which normally only appears 7 to 14 days after bleeding begins. If that appearance shows up on a day-1 scan, it is a clue the bleeding had likely already been happening for a while — meaning it may have started before the baby was even born. Each baby's day-1 scan was then compared with their own later scans, available for the great majority of babies (about 87% at 7–10 days, and about 82% at 14–21 days).

What the Researchers Found

About 4 in 10 babies (141 of 365, or 38.6%) had some kind of abnormal finding on their very first day of life [1]. Not surprisingly, the earliest babies were affected the most: nearly two-thirds (63.8%) of the most extremely premature babies had a finding, compared with about a quarter (26.3%) of the moderate-to-late preterm babies.

Bleeding inside the brain (IVH) was found in about 16% of babies overall, and — importantly — most of it was mild: the great majority of bleeds were the least severe grades (I or II), and only 4 babies in the whole study had one of the more serious grades (III or IV). More than half of the bleeds found on day 1 (31 of 58, or about 53%) already showed the "clot liquefaction" appearance — the sign, described above, that suggests the bleeding may have started before the day-1 scan, and possibly before birth. When researchers followed these babies over time, about a quarter of all the day-1 bleeds (24.1%) had completely gone away by the time babies would normally have gotten their first scheduled scan — and among the bleeds that looked like they'd started earliest (the ones with clot liquefaction), about a quarter of those had also resolved completely on their own.

Changes to the brain's white matter (WM) showed up in about 13% of babies, again mostly in the earliest-born infants. Nearly all of these were a milder type of change on day 1, and by later scans, close to half (44.9%) had resolved completely, while a smaller number went on to become a more serious pattern called cystic periventricular leukomalacia (PVL).

The study also looked at which babies were more likely to have an abnormal day-1 scan. Beyond being born very early, babies with a low Apgar score (a standard 0–10 check of a newborn's condition right after birth) or who needed a breathing tube at birth were more likely to have an abnormal scan, as were babies whose mothers had a womb infection during pregnancy, though this last link was borderline.

What This Does — and Doesn't — Tell Us

It looked back at records from one hospital, so results might look different elsewhere. Not every baby got every follow-up scan (about 87% got the first, 82% the second), so some later changes might have been missed. Telling a fresh (acute) bleed apart from an older (chronic) one on ultrasound isn't always clear-cut, and the researchers say this can occasionally be hard to judge. The idea that some bleeding started before birth is a reasonable inference from how the ultrasound looked, but it wasn't confirmed with any imaging done before birth or by examining the placenta afterward — so it remains an educated guess. The researchers also note that some white-matter changes are a known "nonspecific" finding — sometimes a temporary pattern rather than true injury, consistent with how specialists more broadly classify these changes [8] — which could make the numbers look higher than the true rate of lasting injury.

One possible explanation: the most premature babies may be more prone to sudden bleeding around the time of birth itself, while babies born a little later may more often be affected by slower, ongoing issues during pregnancy, fitting what's known about how brain vulnerability changes with how early a baby is born [9]. This matters especially for the moderate-to-late preterm babies, the largest group in this study, who other research shows can face a higher chance of developmental differences than full-term babies despite often being treated as lower risk [10].

Most importantly, this study did not track how these babies developed later in childhood. The researchers call this a "critical gap" — without knowing whether these day-1 findings, especially the ones that resolved on their own, actually affect a child's later development, it's simply too soon to know how much they matter. Other research has found that even mild or resolved bleeding earlier in life can sometimes still be linked to a slightly higher chance of developmental or learning challenges down the road [11], which is exactly why researchers want to study outcomes directly rather than guess based on the ultrasound picture alone.

What This Means for Families Today, and What's Next

If your baby was born prematurely, this study is not a reason to worry that your hospital's scanning schedule is wrong, and it is not yet a reason to ask for an earlier scan. The researchers are clear: they describe their findings as worth studying further, not proof that anything needs to change now. Any earlier scanning, they say, "should be regarded as a hypothesis to be tested rather than an established recommendation."

What this research does offer is an early, promising signal — the kind of finding that helps scientists design smarter follow-up studies, not a bedside change you'd see today. The pattern found — babies born earliest, or with a rough start (low Apgar scores, needing help breathing, or a mother with a womb infection) — were more likely to have an abnormal day-1 scan, hinting at a future where hospitals might someday focus earlier scanning on the babies most likely to benefit, rather than scanning every premature baby on day one.

The researchers say the next step is bigger, multi-hospital studies that scan babies earlier and also follow them for years afterward to see how they grow and develop — the missing piece needed before this could change how babies are cared for. Until then, the message for families is a reassuring one: this is thoughtful research asking a good question, but it is one study, and your hospital's current care plan continues to reflect the best available evidence today.

References

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  2. Ment LR, Bada HS, Barnes P, et al. Practice parameter: neuroimaging of the neonate: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2002;58(12):1726-1738. doi:10.1212/WNL.58.12.1726 ↩
  3. Hand IL, Shellhaas RA, Milla SS; AAP Committee on Fetus and Newborn, Section on Neurology, Section on Radiology. Routine Neuroimaging of the Preterm Brain. Pediatrics. 2020;146(5):e2020029082. doi:10.1542/peds.2020-029082 ↩
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  9. Kinney HC. The near-term (late preterm) human brain and risk for periventricular leukomalacia: a review. Semin Perinatol. 2006;30(2):81-88. doi:10.1053/j.semperi.2006.02.006 ↩
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