Imaging findings and clinical outcomes in neonates with isolated subependymal echogenicity on cranial ultrasound: a retrospective cohort study

Objective To describe clinical and imaging findings in neonates with isolated subependymal echogenicity on cranial ultrasound and examine associations with recorded mortality and cerebral palsy. Methods This retrospective single-center cohort included 317 neonates admitted between January 2015 and December 2018 with an initial ultrasound finding suspicious for isolated subependymal hemorrhage. Clinical records, available MRI findings, and follow-up information were reviewed. Cerebral palsy was ascertained from rehabilitation or neurology diagnostic records, supplemented by telephone follow-up in January 2026, independently of developmental test scores. The primary adjusted analysis compared death with all survivors using an exploratory six-item comorbidity count and clinical covariates; hospitalization duration was excluded, and laterality was coded as unilateral or bilateral. Results There were 52 deaths (16.4%), 9 survivors with recorded cerebral palsy (2.8%), and 256 survivors without recorded cerebral palsy (80.8%). MRI findings were compatible with hemorrhage in 61 of 90 examined infants (67.8%). In the complete-case mortality model ( n = 316), each additional comorbidity was associated with greater odds of death (adjusted OR, 2.462; 95% CI, 1.787–3.391; p < 0.001). The other included covariates were not statistically significant. White matter abnormalities were recorded in nine infants, including eight of the nine infants with cerebral palsy and one without recorded cerebral palsy. Conclusion Systemic comorbidity burden was associated with mortality within this ultrasound-defined cohort. White matter abnormalities accompanied most recorded cerebral palsy cases, but this observation remains descriptive. Specialist diagnostic records and later telephone follow-up characterize persistent clinical diagnoses; they do not establish the independent effect of subependymal echogenicity or normal development across all domains in survivors without cerebral palsy.