Neuroimaging of Extremely Preterm Infants: Perils of Prediction

Abstract

Neuroimaging, primarily using cranial ultrasound (CUS), is routinely recommended in premature infants who are born at <30 weeks’ gestational age.1 Most premature infants will be imaged with an early CUS examination (generally by 7–10 days of age) to assess for intraventricular or intraparenchymal hemorrhage and for evidence of early white matter injury. The role, timing, and prognostic value of later neuroimaging studies remain unclear. Recent data suggest that white matter and cerebellar injury, which may be more easily detected on MRI scans, is an important link to later neurodevelopmental impairment (NDI).2–4 This observation has led to recommendations that a routine brain MRI examination at term postmenstrual age be performed for all extremely low gestational age newborns (ELGAN) as a way to better predict the risk for NDI.5 In this issue of Pediatrics , Hintz et al6 describe the first large prospective evaluation of early (4–14 days) and near-term (35–42 weeks postmenstrual age) CUS and near-term brain MRI scans in the prediction of NDI at 18 … Address correspondence to Eric C. Eichenwald, MD, Department of Pediatrics, University of Texas Medical School, 6431 Fannin St, MSB 3.020, Houston, TX 77030. E-mail: eric.c.eichenwald{at}uth.tmc.edu