To screen preterm brains at term or not: that is the question

Abstract

The “Choosing Wisely” campaign has identified the “Top 5” opportunities to increase value in newborn medicine, based upon an expert panel reviewing candidate tests and treatments over 3 rounds of a modified Delphi process. Among the panel recommendations was to “avoid routine screening term equivalent or discharge brain MRIs in preterm infants” (Ho et al Pediatrics 2015; 136:e482-9). How authoritative is this admonition? The panel stated that there is “insufficient evidence that the routine use of term-equivalent or discharge screening brain MRIs in preterm infants improves long-term outcome.” Insufficient evidence points to a lack of study or lack of power, equivalent to a high potential for a false negative, ie, type II error, but not the availability of data to conclude that these MRIs do or do not make a difference in the management of these children. When should we image the brain of prematures at term? In this issue of The Journal Anderson et al report their results from a cohort of 186 very premature infants, born at less than 30 weeks' gestation at a single institution and who had both MRI at term equivalent age followed by neurodevelopmental assessment at age 7. Quantitative evaluation of imaging predicted outcome at age 7, independent of clinical and social factors. Thus, MRI findings can be used to target interventions for children at high risk for subsequent developmental difficulties and also guide families about the developmental risks and future of their children. We will likely continue to see more studies like this. Where do we go from here? We still need prospective studies that demonstrate whether any interventions benefit those prematures found to be at risk by MRI. In the meantime, are we ethically bound to perform MRIs at term, attempt to improve the developmental outcome of children at risk for delays, and share with families the results that potentially foretell the development of their child? While future research is needed, an agnostic approach right now denying all “routine” brain MRIs at term for children born too early seems premature. We need to pay close attention to ongoing developments in this area of neonatology and child development. Article page 58 ▶ Associations of Newborn Brain Magnetic Resonance Imaging with Long-Term Neurodevelopmental Impairments in Very Preterm ChildrenThe Journal of PediatricsVol. 187PreviewTo determine the relationship between brain abnormalities on newborn magnetic resonance imaging (MRI) and neurodevelopmental impairment at 7 years of age in very preterm children. Full-Text PDF