Targeted US Screening Helps Detect Disease Early in High-Risk Infants
Guidance helps radiologists use pediatric US when early detection can alter care
In concert with the RadioGraphics monograph, RSNA News shares the latest on the role of medical imaging in disease screening.
Serious diseases in newborns and infants are not always apparent at birth. In some high-risk children, abnormalities may remain clinically silent until complications develop.
For infants whose prematurity, prenatal findings, congenital conditions or genetic predisposition place them at increased risk, targeted US screening can identify disease during a window when treatment, additional imaging or specialist referral may prevent long-term consequences.
“We wanted to create a reference document for all the different US screening exams that are performed in newborns and young infants,” said Hansel J. Otero, MD, vice chair for clinical research in the Department of Radiology at Children’s Hospital of Philadelphia, and associate professor of radiology at the Perelman School of Medicine at the University of Pennsylvania.
Dr. Otero co-authored a RadioGraphics review that brings together evidence-based US screening recommendations for several high-risk pediatric populations, including premature infants, breech newborns, children with congenital conditions and syndromes, including tumor predisposing syndromes. The review addresses who should undergo screening, when examinations should be performed and which findings should prompt further care.
“Many residents, and hence general radiologists, might not be familiar with all the indications, technical details, interpretation and their impact on management,” Dr. Otero said. “This review is meant for those residents and general radiologists looking for a single reference that makes them up to date in basic screening ultrasound studies for newborns and infants.”
Although these examinations are common in pediatric radiology practices, familiarity with them can vary.
Focus Screening on Infants at Elevated Risk
Dr. Otero and colleagues emphasize that imaging screening in newborns and infants should generally be targeted to populations with established risk factors rather than applied universally.
In low-risk populations, indiscriminate imaging can increase false-positive findings, unnecessary follow-up examinations, parental anxiety and downstream interventions without improving outcomes.
“Fortunately, the prevalence of serious and actionable congenital anomalies is low,” Dr. Otero said.
More imaging also does not necessarily mean more clinically important diagnoses. Dr. Otero pointed to increased screening for developmental dysplasia of the hip (DDH) and additional renal and bladder US for mild prenatal urinary tract dilatation as examples in which greater utilization may increase false-positive findings and downstream interventions without identifying more cases requiring intervention.
Although the review does not quantify potential cost savings, targeted screening may also reduce unnecessary healthcare costs by limiting follow-up imaging and interventions in infants unlikely to benefit from screening.
When screening is justified, however, US offers several advantages.
“Ultrasound is an ideal screening modality because of its well-known safety profile, portability and great temporal and spatial resolution,” Dr. Otero said.
Those advantages are particularly important in newborns and infants, who are more susceptible to ionizing radiation. Their developing anatomy also creates acoustic windows that later disappear, allowing US evaluation of the brain through the fontanelle, the spinal canal via incompletely ossified vertebral elements, and the cartilaginous hip.
Findings of hip dysplasia in a 2-week-old boy with a history of breech delivery. (A) Coronal neutral US image shows decreased coverage of the femoral head (*) and a round appearance of the acetabulum (arrow). The α angle was 50° (not shown). (B) Coronal US image at flexion shows rounding of the ilium (arrow) and a prominent pulvinar (#).
https://doi.org/10.1148/rg.260058 ©RSNA 2026
Early Imaging Can Change Treatment
According to Dr. Otero, premature infants provide one of the clearest examples of targeted screening.
Infants born at 30 weeks’ gestation or earlier are at increased risk for germinal matrix-intraventricular hemorrhage and white matter injury. Serial cranial US is generally performed at seven to 10 days, again at four to six weeks and at term-equivalent age. The sequence allows radiologists to identify evolving injury and monitor complications such as posthemorrhagic hydrocephalus.
“The goal of these screening studies is early appropriate management,” Dr. Otero said.
That principle also applies to infants at risk for DDH, and spinal dysraphism—a group of congenital conditions in which the spine and spinal cord don’t develop normally during pregnancy.
High-risk lumbosacral skin findings can signal occult spinal abnormalities that may remain asymptomatic until neurologic or urologic dysfunction develop. US performed during the first three to four months of life can identify findings associated with tethered cord while the spinal canal remains accessible via sonograph.
Dr. Otero said early identification of closed spinal dysraphism and tethered cord can help prevent long-term complications including neurogenic bladder, bowel dysfunction and scoliosis.
Similarly, US in infants at risk for DDH can distinguish physiologic immaturity from dysplasia or instability. Dysplastic or unstable hips can prompt orthopedic referral and early abduction bracing, potentially avoiding corrective surgery later in childhood.
In each of these screening scenarios, timing plays a critical role in determining the value of the examination.
Timing Can Determine Accuracy
Dr. Otero emphasized that effective screening depends not only on selecting the appropriate examination, but also on performing it at the right developmental stage.
Postnatal renal and bladder US for prenatal urinary tract dilatation generally should be performed after the first 48 hours of life. Earlier imaging can underestimate collecting-system dilatation because of physiologic neonatal oliguria and transitional renal function.
Hip US presents a different challenge. In infants with risk factors but a normal physical examination, screening is typically performed at four to six weeks because imaging too soon may mistake normal physiologic immaturity for abnormal findings.
“When imaging is performed too early, it underestimates the degree of urinary tract dilation. Early imaging can also result in more indeterminate cases, requiring follow-up in tethered cord screening and generating more false-positive results in hip dysplasia screening,” Dr. Otero said.
Delayed imaging can also have consequences. Dr. Otero noted that high-risk urinary tract dilatation can result in loss of renal function, while disseminated hepatic hemangiomas can lead to serious complications including high-output heart failure and hypothyroidism.
Standardization Turns Findings Into Action
Dr. Otero and his coauthors stress that screening is most effective when acquisition, interpretation and follow-up are standardized.
“The idea of a standard imaging acquisition protocol and structured interpretation is to guide clinicians towards appropriate management and allow for proper counseling of the families in terms of long-term planning and outcomes,” Dr. Otero said.
Classification systems help translate imaging findings into clinical decisions.
In premature infants, the severity of intracranial hemorrhage can influence follow-up frequency, prognosis and the need for neurosurgical consultation.
For urinary tract dilatation, standardized postnatal risk categories can distinguish children who need conservative US follow-up from those who warrant additional evaluation for reflux, obstruction or renal dysfunction.
Familiarity with normal developmental findings and benign variants is equally important. Dr. Otero said lack of familiarity can lead to unnecessary specialist referrals, repeat US examinations, confirmatory MRI and additional stress for families.
Surveillance Can Detect Tumors Before Symptoms
Risk-based US screening also plays an important role in children with hereditary cancer predisposing syndromes.
For example, children with Li-Fraumeni syndrome undergo structured surveillance that includes abdominal and pelvic US beginning in infancy, while those with Beckwith-Wiedemann spectrum undergo serial abdominal US with serum alpha-fetoprotein testing to screen for malignancies such as hepatoblastoma and Wilms tumor.
Because surveillance is performed in asymptomatic children, tumors may be detected when they are smaller and at an earlier stage. Suspicious or indeterminate findings can then lead to MRI and oncology referral.
Across screening indications, Dr. Otero emphasized that identifying abnormality is only one part of the radiologist’s responsibility.
“All radiology departments performing these studies must ensure prompt and adequate communication of findings to referring clinicians,” he said. “Moreover, the development of follow up imaging and referral guidelines helps radiologists contextualize their findings and avoid confusion while improving diagnostic confidence.”
For More Information
Access the RadioGraphics article, “Targeted US Screening in High-Risk Newborns and Infants: Indications, Techniques, and Disease Findings.”
Read previous RSNA News stories on pediatric imaging: