 Hello, I am Dr. Shibin Samson, junior resident, department of radio diagnosis from K.S. Ignorant Medical Academy in Nangalore. I am wrestling a paper on the role of Neurosonogram in germinol matrix hemorrhage. Coming to the background, germinol matrix in intraventricular hemorrhage is one of the most common devastating intra-cranial complications in pre-term units, especially those born before 32 weeks of gestation and very low birth weight infants. The gold standard for diagnosing germinol matrix hemorrhage has been high-resolution real-time cranial ultrasound, which has a 96-percentage sensitivity and 94-percentage specificity for identifying intra-cranial hemorrhage. The aim of the study is to assess the role of Neurosonogram in evaluation of germinol matrix hemorrhage neonates admitted in NICU. Introduction Neurosonogram is an essential and emerging part of routine neonatal care, particularly in case of pre-term units. NSG is easily available non-invasive investigation modality for neonatal cranial showing normal brain development and any continental or acquired abnormalities of perinatal brain, as well as brain injuries in pre-term units. In days following the delivery, pre-term units are susceptible to brain injuries, commonly intraventricular hemorrhage, perinventricular hemorrhage and white matter injury. The recent format is not truly understood, but attributed to fragile cerebrate blood pressure. German matrix hemorrhage can be classified into four based on the NSG findings, and they are grade 1, German matrix hemorrhage alone, grade 2 with intraventricular hemorrhage, but without ventricular dilatation, grade 3 intraventricular hemorrhage with ventricular dilatation, and grade 4 with intra-perinfemoral hemorrhage. So, in a coronal way, there are four views that we use to assess the fetal head. So, the first one is trans-frontal plane, then the trans-codate, trans-celemic and trans-cervilac plane. So, the trans-frontal plane, where the inner hemispheric fissure is visible between the two frontal lobes, the spinoid bone forming the roots of the orbits as well as the orbits themselves are also visible. In trans-codate plane, the two frontal lobes are displayed on either side of the CSP, cross-section of the anterior part of the body of corpus callosum is also evident as a mildly hypoechoic band on top of the CSP and between the frontal lobes. The trans-celemic plane, the thalamus and insular are indicated. In trans-ceribular plane, those spital haunts of the lateral ventricles and cerebellum are seen. The different images, we can see the body of corpus callosums, plain in general, rostrum, codothalamic groove, brainstem, fourth ventricle and venus. In the second image, we can see the trans-celemic plane. In the third image, we can see the trans-ceribular plane. In the fourth one, we can see the trans-frontal and trans-codate plane. And the last one is showing the cerebral vasculature. The methods what we use in the study type is an observational study. Study design is a cross-section of descriptive study. Study setting, Justice K. Sigtate Charitable Hospital, Arrest 2, Midday University. Study duration is from 1, 10, 2022 to 30, 10, 2023. Study population neonates who are admitted in NICU of Justice K. Sigtate Charitable Hospital, Bangalore. The sample size is 30. And inclusion criteria, neonates admitted in NICU who are referred to the radiology department for routine energy study and are diagnosed with general matrix hemorrhage. Neurosonogram will be performed using sonocyte fujifilip, terpo, with 5 mga arcs, phased array probe in the NICU. The observations and results. Among the subjects out of the 30 cases, 18 were mates and 12 were females. And 12 cases were pre-term. 16 cases were termed and 2 were post-term. Out of the total 30 cases, we classified the neonates based on the birth weight. So, 1 case was less than 1000, 10 cases between 1000 and 2000. 18 cases were between 2000 and 3000. And 1 case was more than 3000 grams. And all 30 neonates were diagnosed with general matrix hemorrhage. And out of this, 46 percentage had grade 1. 26 percentage had grade 2. And 20 percentage, grade 3. And 6 percentage, grade 4 hemorrhage. Out of the 12 pre-term neonates, 3 had grade 1 hemorrhage, 5 had grade 2 hemorrhage, 2 had grade 3. And 2 had grade 4 hemorrhage. Out of the 16-term neonates, 10 had grade 1 hemorrhage, 2 had grade 2, 4 had grade 3 hemorrhage. Out of the 2 post-term neonates, 1st neonate had grade 1 hemorrhage, 2nd neonate had grade 2 hemorrhage. The neonates with birth rate below 1000 had grade 3 hem, German matrix hemorrhage. M in the neonates between 1000 and 2000, 12 cases at grade 1, 5 cases at grade 2 and 1 case at grade 3 hemorrhage. M in the neonates between 2000 and 3000 gram, 2 cases at grade 1, 2 cases at grade 2, 4 cases at grade 3 and 2 cases with grade 4 hemorrhage is not done. And the neonates with more than 3000 gram birth rate showed grade 2 hemorrhage. Coming to some of the images. First one we can see a hyperwoquic stripe in the left colothalamic group which is suggestive of grade 1 German matrix hemorrhage which is indicated by the white arrow. In the second image we can see hyperwoquic changes in the right colothalamic group with ipsilateral bulky coroed plexus and it is suggestive of grade 2 German matrix hemorrhage. So the figure 3, hyperwoquic changes in bilateral colothalamic group with extension into the third ventricle and mind dilatation of bilateral lateral ventricles are noted which is suggestive of grade 3 German matrix hemorrhage. In the last picture we can see bilateral German matrix hemorrhage with intralentricular and panchemal hemorrhage. Right left side more than left, left side more than right which is suggestive of grade 4 hemorrhage. Discussion. 30 cases of German matrix hemorrhage were enrolled in the study. Out of this 12 cases were pre-term, 16 were termed and 2 were posted. Of the 30 participants 18 cases were females and 12 were males and 12 were females. Birth weight were also recorded in all the cases. Among the 30 patients 14 had grade 1 German matrix hemorrhage, 8 had grade 2 hemorrhage, 6 had grade 3 hemorrhage and 2 showed grade 4 hemorrhage. Further on comparing the grade of hemorrhage with birth weight the units with less than 1000 gram short grade 3 hemorrhage. Between 1000 and 2000 gram showed 18 cases of hemorrhage. Between 2000 and 3000 gram weight category 10 cases of hemorrhage and last in more than 1000 one case of grade 2 hemorrhage is noted. Now it is the use of neuro sonogram screening. For pre-term neonates plays a crucial role in assessing their neurodevelopmental outcome. Neuro sonogram in identify brain damage and its evolution is highly efficacious on regular follow-up which provides information that guides clinical decision and prognosis. Therefore, neuro sonogram plays a potential role in preventive, protective and rehabilitative strategies in the management of critically ill neonates. The study concludes NSG as a choice of investigation modality in NICU which effectively documents neuro abnormalities more predominantly German matrix hemorrhage.