A neonatal cranial ultrasound (or transfontanellar ultrasound) is a safe, painless scan used to examine the brain of newborn babies, especially those born prematurely or who had a difficult birth. Because a baby's skull bones are not fully joined at birth, they have "soft spots" (fontanelles). The ultrasound probe can scan through these soft spots to get clear images of the brain tissue and fluid spaces.
This scan uses sound waves and does not use any radiation, making it completely safe for newborns.
Common Indications for a Neonatal Cranial Ultrasound
- Screening premature infants (born before 34 weeks) for brain bleeding (intraventricular hemorrhage).
- Monitoring babies who experienced a lack of oxygen during birth (birth asphyxia).
- Checking for fluid build-up in the brain (hydrocephalus).
- Investigating suspected brain infections, such as meningitis.
- Evaluating congenital brain abnormalities or cysts.
What exactly does a neonatal cranial ultrasound show?
The scan shows the structure of the baby’s brain, including the ventricles (fluid-filled spaces) and the surrounding brain tissue. It helps detect bleeding, fluid accumulation, cysts, or areas of damage due to lack of oxygen.
How should I prepare my baby for a neonatal cranial ultrasound?
No special preparation is needed. The baby does not need to fast. It is highly recommended to feed the baby just before the scan. A fed, warm baby is more likely to sleep or remain calm during the scan, which makes the procedure much easier.
Do I need to stop giving my baby medication?
No. Continue giving your baby any prescribed medications as instructed by their pediatrician.
What happens when we arrive for the scan?
The scan can be performed in the neonatal intensive care unit (NICU) at the baby's incubator or in a private scan room. You can remain next to your baby. The baby will lie on their back on a flat surface, or you may be allowed to hold them.
How is the procedure performed?
The radiographer will apply a small amount of warm gel to the baby’s anterior fontanelle (the soft spot on top of the head). They will gently place the ultrasound probe on the soft spot and tilt it in different directions to capture images of the brain from various angles. The baby will not feel any pain.
How long does a neonatal cranial ultrasound take?
The scan is very quick, taking about 10 to 15 minutes. The radiographer works efficiently to minimize any disturbance to the baby.
Is there any discomfort?
No. The scan is completely painless. The baby will only feel the wet gel and the light touch of the plastic probe on their head. Many babies sleep through the entire procedure.
Are there risks?
No. This scan uses sound waves and has no radiation or side effects. It is completely safe for newborn babies.
Can older children have this scan?
No. This scan can only be performed as long as the fontanelle (soft spot) remains open, which usually closes by 12 to 18 months of age. Once closed, an MRI or CT scan must be used to image the brain.
Can I have this scan if I am pregnant?
This scan is performed on newborn babies, not adults.
When will we get the results?
A pediatric radiologist will review the images. The results will be discussed with your baby's pediatrician, who will explain them to you immediately or during the daily rounds if your baby is in the hospital.
What if the scan finds something?
If the scan detects bleeding or fluid build-up, the pediatrician will monitor the baby closely. Many mild bleeds resolve on their own with no long-term issues. If fluid is building up, the team can plan interventions to relieve the pressure.
When should my baby receive urgent assessment?
Seizures, repeated pauses in breathing, marked lethargy, a tense or bulging fontanelle, poor feeding with reduced responsiveness, or sudden deterioration needs urgent neonatal assessment. Cranial ultrasound is limited by the acoustic windows and may not show every injury; MRI or CT may be needed when clinically justified.
What are the important limitations?
Ultrasound does not use ionising radiation, but a useful result still depends on the clinical question, the operator, the equipment, patient anatomy, and whether the target can be reached by sound waves. Gas, bone, body habitus, pain, movement, and a limited acoustic window can hide disease. A normal scan does not automatically exclude the suspected condition; persistent or worsening symptoms need clinical reassessment and sometimes repeat ultrasound, CT, MRI, laboratory tests, or another specialist test.
Ultrasound should be used for a medical purpose, with output and examination time kept as low as reasonably achievable—especially in pregnancy and with Doppler. Internal scans and procedures require explanation, consent, privacy, and a chaperone according to patient preference and local policy.
Questions to ask your care team
- What exact question should this ultrasound answer, and could anything important remain unseen?
- Is this a screening, diagnostic, surveillance, or procedure-guidance examination, and will the result change care?
- What preparation is required, and should I continue all medicines unless my own clinician gives different instructions?
- When will I receive the signed report, who will explain it, and what symptoms should prompt urgent assessment rather than waiting?
Sources and further reading
Conclusion
A neonatal cranial ultrasound is a gentle and safe way to check your newborn baby’s brain health. To help keep your baby calm, bring a pacifier, favorite blanket, or feed them right before the appointment.