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Mark L. Hudak MD, Guest Contributor
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MRI at Discharge for ELBW
Neonatal Brain Magnetic Resonance Imaging Before Discharge Is Better Than Serial Cranial Ultrasound in Predicting Cerebral Palsy in Very Low Birth Weight Preterm Infants. Mirmiran M, Barnes PD, Keller K, et al. Pediatrics 2004;114:992-8.
Objective. To compare the value of
serial cranial ultrasound (US) with a single magnetic resonance
imaging (MRI) before discharge in very low birth weight preterm
infants to predict cerebral palsy (CP).
Methods. Infants who weighed <1250 g at birth and were <30
weeks' gestational age underwent conventional brain MRI at near term
(36–40 weeks' postmenstrual age) and gradient recalled echo images were
obtained. Cranial US were also obtained at least twice during the
first 2 weeks of life. MRI and US images were interpreted by 2
independent radiologists, who were masked to clinical outcome, and
scored as follows: category 1, no abnormality; category 2,
subependymal hemorrhage or mineralization; category 3, moderate to
severe ventriculomegaly; category 4, focal parenchymal abnormality
with or without ventriculomegaly. For the purpose of this study,
1 and 2 were categorized as "normal," and 3 and 4 were categorized
as "abnormal." The infants were assessed at a mean age of 20
and 31 months using the Amiel-Tison standardized neurodevelop-mental
examination.
Results. The sensitivity and specificity of MRI for predicting
CP were 71% and 91% at 20 month and 86% and 89% at 31 months,
respectively. The sensitivity and specificity of US for predicting CP
were 29% and 86% at 20 months and 43% and 82% at 31 months.
Conclusions. As a predictor of outcome for CP, MRI at near-term
in very low birth weight preterm neonates is superior to US.
However, both US and MRI demonstrate high specificity.
Commentary:
This is something to consider in our nursery protocols for VLBW infants. One
rational approach, given this information, is to use ultrasound to screen for
IVH in the first week of life and then to limit subsequent studies to those
infants at risk for posthemorrhagic hydrocephalus. All infants could then be
screened for periventricular leukomalacia by an MRI between 36-40 weeks
postconceptional age, which would increase the sensitivity for predicting CP
without sacrificing specificity. Is anyone already performing MRIs routinely
in this population? MLH.
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