Neuroimaging practices in very low birth weight neonates

Abstract

Objective: Cranial ultrasound (CUS) and magnetic resonance imaging (MRI) are used to detect brain injury in very low birth weight (VLBW) neonates. Our study attempts to determine the abnormalities found on physician-selected MRI compared to CUS findings and whether any infant characteristic can predict new MRI-detected abnormalities. Methods: Radiology reports of neonates admitted between 2010 and 2014, with birth weights between 501 and 1500 g, were retrospectively reviewed. We excluded infants who died or were transferred and those with a major congenital malformation. Reports were individually reviewed for pertinent positive findings. In addition, various perinatal and maternal characteristics were collected from the electronic medical record. Receipt of MRI and MRI findings were compared with respect to perinatal and maternal characteristics. Results: Out of the 605 VLBW neonates evaluated for the study, 94 infants received MRI. Among the infants with MRI, 43 (46%) had significant findings and 17 (18%) had new significant findings not found by CUS. The MRI did not detect any new intraventricular hemorrhage (IVH) and ventriculomegaly or cystic periventricular leukomalacia (PVL). Infants who had lower gestational age, longer length of stay, lower birth weight, and who had severe IVH, PVL, severe retinopathy of prematurity, or bronchopulmonary dysplasia had significantly higher odds of receiving MRI. Findings from MRI (exclusive or nonexclusive) were not significantly associated with any perinatal characteristic. Conclusions: Although routine use cannot be recommended, physician-selected MRI has a relatively high detection rate of exclusive findings and can potentially increase detection rate.