A moderately preterm, 2.68 kg, male child was born to para 3 live 3 mother by Cesarean delivery done in view of preterm labor with fetal ascites. The baby had antenatally detected ascites. The baby had distended but soft abdomen. Ultrasound abdomen showed gross ascites. X-ray of the abdomen in supine showed faint lucency in the mid-abdomen region posterior to the bowel gas, which was visualized as free gas along the right half of the abdomen in lateral decubitus position, suggestive of bowel perforation. Laparotomy was done on day three of life, intraoperatively found to have perforated Meckel's diverticulum. Ascites resolved postoperatively. Isolated fetal ascites is a rare condition but has a favorable prognosis.

The holoprosencephalies (HPEs) are a group of disorders that are characterized by a failure of differentiation and midline cleavage of the prosencephalon, which usually occurs between days 18 and 28 of gestation. HPE has been divided into three subcategories based on the structural malformation: alobar, semilobar, and lobar HPE. Middle interhemispheric variant (MIH) or syntelencephaly is also considered as a milder variant of HPE. It is estimated to occur in 1/16,000 live births and 1/250 conceptuses. HPE is caused by genetic factors or environmental factors and teratogens. Clinical presentation depends on the severity of the malformation. Severe cases are usually associated with facial abnormalities like hypertelorism or midline facial clefts. HPE is diagnosed prenatally by ultrasound and MRI. Treatment of HPE is supportive and symptomatic. The clinical outcome depends on the severity of HPE and associated medical and neurological complications.

Neuroimaging plays a key role in management of critically ill neonates with neurological problems. Magnetic Resonance Imaging (MRI) is the most commonly used neuroimaging modality in evaluation of neonatal encephalopathy, because MRI provides better image quality and accurate delineation of the lesion. Newer modalities of MRI like Diffusion Weighted Imaging (DWI), Diffusion Tensor Imaging (DTI) are useful in identifying the brain lesion and also in predicting the neurodevelopmental outcome. Magnetic Resonance Angiography (MRA) and Magnetic Resonance Venography (MRV) are used to assess the cerebral arteries and veins with or without the use of contrast material. Arterial Spin Labelling (ASL) MRI and Phase Contrast (PC) MRI are newer modalities of MRI used to assess the cerebral perfusion without the use of contrast material. Magnetic Resonance Spectroscopy (MRS) is a functional MRI modality used to assess the level of brain metabolites which help us in diagnosing neuro metabolic disorders, peroxisomal disorders and mitochondrial disorders. Several predictive scores are available based on the size and location of lesions in MRI, and these scores are used to predict the neurodevelopmental outcome in term neonates with encephalopathy. MRI at term equivalent age in preterm neonates used to predict neurodevelopmental outcome in later life.

Neonatal encephalopathy (NE) is a significant problem and is associated with high morbidity and mortality. NE can result from diverse etiologies. Identifying the etiology of NE can guide us in giving appropriate treatment. Magnetic resonance imaging (MRI) is the most common modality of neuroimaging used in evaluation of NE. Conventional MRI sequences along with advanced MRI techniques such as magnetic resonance spectroscopy and diffusion weighted imaging are useful in identifying the etiology of NE. This review elaborates the role of MRI in various etiologies of NE.

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