{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T10:51:33Z","timestamp":1782471093414,"version":"3.54.5"},"reference-count":41,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Severe brain injury (SBI) in very preterm infants includes heterogeneous lesions with distinct timing, burden and outcomes. We used cranial ultrasound (CUS) to describe SBI entity, documented timing, three-domain burden, deaths following documented withdrawal, withholding or non-escalation of life-sustaining treatment for poor neurological prognosis (neuro-WWLST), and survivor outcomes. Methods: Retrospective single-center cohort (1991\u20132020) of 2841 very preterm infants (&lt;32 weeks\u2019 gestation and\/or birth weight \u2264 1500 g) with complete CUS within 48 h after birth. CUS was summarized by four windows, three domains\u2014parenchymal lesion, intraventricular hemorrhage (IVH) and ventriculomegaly\u2014and three mutually exclusive entities: periventricular hemorrhagic infarction (PVHI), cystic periventricular leukomalacia (cPVL and grade 3 IVH without PVHI\/cPVL (IVH3 entity). Cross-outcome analyses used common maximal-burden CUS. Results: SBI occurred in 286\/2841 infants (10.1%) and neuro-WWLST death in 45\/2841 infants (1.6%); 43\/45 occurred within SBI, and 43\/89 SBI deaths (48.3%) followed documented neuro-WWLST. Using common maximal-burden CUS, severe three-domain involvement was more frequent among neuro-WWLST deaths than survivors (37.2% vs. 8.6%). Among SBI survivors with follow-up, cerebral palsy (CP) occurred in 87\/176 (49.4%) and clinically classified school-age cognitive sequelae in 50\/155 (32.3%). Outcomes varied by entity, with mainly ambulatory unilateral CP after PVHI, more frequent non-ambulatory bilateral CP after cPVL, and a heterogeneous IVH3 profile. Severe three-domain involvement identified a small subgroup with higher outcome burden, but outcomes were not deterministic. Conclusions: A structured, descriptive CUS approach separating lesion entity, documented timing and multidomain burden may support transparent cohort-level description of SBI trajectories, documented neuro-WWLST deaths and survivor outcomes.<\/jats:p>","DOI":"10.3390\/children13070844","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T08:43:57Z","timestamp":1782463437000},"page":"844","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Three-Domain Serial Cranial Ultrasound Phenotypes and Outcomes in Very Preterm Infants with Severe Brain Injury: A Single-Center Cohort Study"],"prefix":"10.3390","volume":"13","author":[{"given":"Noem\u00ed","family":"N\u00fa\u00f1ez-Enamorado","sequence":"first","affiliation":[{"name":"Division of Pediatric Neurology, Hospital Universitario 12 de Octubre, Avenida de C\u00f3rdoba s\/n, 28041 Madrid, Spain"},{"name":"Program in Research in Medical and Surgical Sciences, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Camacho-Salas","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurology, Hospital Universitario 12 de Octubre, Avenida de C\u00f3rdoba s\/n, 28041 Madrid, Spain"},{"name":"Program in Research in Medical and Surgical Sciences, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"L\u00f3pez-Maestro","sequence":"additional","affiliation":[{"name":"Neonatology Unit, Hospital Universitario 12 de Octubre, Avenida de C\u00f3rdoba s\/n, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9565-4012","authenticated-orcid":false,"given":"Mar\u00eda Carmen","family":"Gallego-Herrero","sequence":"additional","affiliation":[{"name":"Division of Pediatric Radiology, Hospital Universitario 12 de Octubre, Avenida de C\u00f3rdoba s\/n, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4566-5623","authenticated-orcid":false,"given":"Ana","family":"Mart\u00ednez de Arag\u00f3n","sequence":"additional","affiliation":[{"name":"Division of Pediatric Radiology, Hospital Universitario 12 de Octubre, Avenida de C\u00f3rdoba s\/n, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Vila-Bedmar","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurology, Hospital Universitario 12 de Octubre, Avenida de C\u00f3rdoba s\/n, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"V\u00e1zquez-Rom\u00e1n","sequence":"additional","affiliation":[{"name":"Neonatology Unit, Hospital Universitario 12 de Octubre, Avenida de C\u00f3rdoba s\/n, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berta","family":"Zamora-Crespo","sequence":"additional","affiliation":[{"name":"Division of Neuropsychology, Hospital Universitario 12 de Octubre, Avenida de C\u00f3rdoba s\/n, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen Rosa","family":"Pall\u00e1s-Alonso","sequence":"additional","affiliation":[{"name":"Program in Research in Medical and Surgical Sciences, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain"},{"name":"Neonatology Unit, Hospital Universitario 12 de Octubre, Avenida de C\u00f3rdoba s\/n, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0766-7169","authenticated-orcid":false,"given":"Mar\u00eda Teresa","family":"Moral-Pumarega","sequence":"additional","affiliation":[{"name":"Program in Research in Medical and Surgical Sciences, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain"},{"name":"Neonatology Unit, Hospital Universitario 12 de Octubre, Avenida de C\u00f3rdoba s\/n, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"113600","DOI":"10.1016\/j.jpeds.2023.113600","article-title":"The Impact of Intraventricular Hemorrhage and Periventricular Leukomalacia on Mortality and Neurodevelopmental Outcome in Very Preterm and Very Low Birthweight Infants: A Prospective Population-based Cohort Study","volume":"262","author":"Pascal","year":"2023","journal-title":"J. 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