Neuroimaging at Term Equivalent Age: Is There Value for the Preterm Infant? A Narrative Summary

Banihani, Rudaina; Seesahai, Judy; Asztalos, Elizabeth; Church, Paige

doi:10.3390/children8030227

Cited by 6 publications

(4 citation statements)

References 174 publications

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“…Cranial ultrasound is traditionally the modality of choice for screening intracranial lesions in preterm infants. At near-term or before discharging an infant from a neonatal intensive care unit (NICU), brain magnetic resonance imaging (MRI) is often recommended to determine an early prognosis and as a potential guide for early intervention 3) . However, MRI is sensitive to motion artifacts; therefore, immobilization during the test is essential to obtain images of sufficient quality in infants.…”

Section: Introductionmentioning

confidence: 99%

Implementation of the Feed and Swaddle Technique as a Non-Pharmacological Strategy to Conduct Brain Magnetic Resonance Imaging in Very Low Birth Weight Infants

Yoo

Park

et al. 2021

Neonatal Med

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Purpose: Magnetic resonance imaging (MRI) is a useful tool for evaluating brain injury and maturation in preterm infants and often requires sedation to acquire images of sufficient quality. Infant sedation is often associated with adverse events, despite extreme precautions. In this study, the swaddling technique was investigated as an alternative non-pharmacological strategy to obtain brain MRIs of sufficient quality.Methods: We applied the feed and swaddle technique during routine brain MRI as a quality improvement project and compared its morbidity with that of sedation in a historic age-matched group. Seventy-nine very low birth weight infants in the neonatal intensive care unit of Ajou University Hospital (Suwon, Korea) were enrolled. Thirty-two (40.5%) infants were in the feed and swaddling group, and 47 (59.5%) were in the sedation group.Results: The morbidity associated with the cardiopulmonary system (swaddling group vs. sedation group: 53.13% [n=17] vs. 63.83% [n=30], P=0.723) and central nervous system (40.63% [n=13] vs. 29.79% [n=14], P=0.217) were not significantly different between groups. The MRI failure rate was not significantly different (swaddling group vs. sedation group: 12.5% [n=4] vs. 4.3% [n=2], P=0.174). The MRI scanning time was longer in the swaddling group than in the sedation group (76.5±20.3 minutes vs. 61.5±13.6 minutes, P=0.001). Cardiopulmonary adverse events were significantly less common in the swaddling group than in the sedation group (3.13% [n=1] vs. 34.04% [n=16], P=0.002).Conclusion: The success rate of MRI was comparable between the swaddling technique and sedation. Furthermore, despite the drawback of prolonged scan time, cardiopulmonary adverse events are fewer with swaddling than with sedative agents. Therefore, swaddling can be an alternative to sedation or anesthesia when performing neonatal MRI scans.

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Section: Introductionmentioning

confidence: 99%

Implementation of the Feed and Swaddle Technique as a Non-Pharmacological Strategy to Conduct Brain Magnetic Resonance Imaging in Very Low Birth Weight Infants

Yoo

Park

et al. 2021

Neonatal Med

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“…16 In the current era, neonatologists often rely on information obtained from term equivalent age (TEA) MRI to predict long-term developmental outcomes by recognizing wellknown patterns such as gyral maturation of grey matter or white matter lesions. 17,18 Traditionally, these interpretations have been performed by expert neuroradiologists, and neonatologists combine clinical information to provide subjective explanations in real-world clinical practice.…”

Section: Resultsmentioning

confidence: 99%

Development and Validation of MRI-based Brain Volumetry Model Predicting Poor Psychomotor Outcomes in Preterm Neonate

Park,

Han,

Song

et al. 2024

Preprint

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Background Infant FreeSurfer was introduced to address robust quantification and segmentation in the infant brain. The purpose of this study is to develop a new model for predicting the long-term neurodevelopmental outcomes of very low birth weight preterm infants using automated volumetry extracted from term-equivalent age (TEA) brain MRI, diffusion tensor imaging, and clinical information. Methods Preterm neonates hospitalized at Severance Children’s Hospital, born between January 2012 and December 2019, were consecutively collected. Inclusion criteria included infants with birth weights under 1500 g who underwent both TEA MRI and Bayley Scales of Infant and Toddler Development 2nd Edition (BSID-II) assessments at 18–24 months of corrected age (CA). Brain volumetric information was derived from Infant FreeSurfer using 3D T1WI of TEA MRI. Mean and standard deviation of fractional anisotropy of posterior limb of internal capsules were measured. Demographic information and comorbidities were used as clinical information. Study cohorts were split in training and test set with 7:3 ratio. Random forest and logistic regression models were developed to predict low Psychomotor Development Index (PDI < 85) and low Mental Development Index (MDI < 85), respectively. Performance metrics, including the area under the receiver operating curve (AUROC), accuracy, sensitivity, precision, and F1 score, were evaluated in test set. Results A total of 150 patient data were analyzed. For predicting low PDI, the random forest classifier was employed. The AUROC values for models using clinical variables, MR volumetry, and both clinical variables and MR volumetry were 0.8435, 0.7281, and 0.9297, respectively. To predict low MDI, a logistic regression model was chosen. The AUROC values for models using clinical variables, MR volumetry, and both clinical variables and MR volumetry were 0.7483, 0.7052, and 0.7755, respectively. The model incorporating both clinical variables and MR volumetry exhibited the highest AUROC values for both PDI and MDI prediction. Conclusion In conclusion, a new prediction model utilizing an automated volumetry algorithm significantly distinguishes the long-term psychomotor developmental outcomes of preterm infants. This model can provide additional information in clinical settings without requiring specialized expertise.

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“…Cranial magnetic resonance imaging (cMRI) at term equivalent age (TEA) or before discharge from the neonatal intensive care unit (NICU) is increasingly becoming a part of standard practice [ 2 ]. Detailed cMRI, in conjunction with other clinical tools, helps in prognostication and guides early intervention therapy [ 3 ]. In addition, central nervous system (CNS) anomalies, pre-, and post-congenital heart disease surgery, hypoxic-ischemic encephalopathy, genetic abnormalities, seizure disorder, and post-major surgery in the neonatal period such as congenital diaphragmatic hernia repair are a few other indications/reasons for cMRI.…”

Section: Introductionmentioning

confidence: 99%

Intervention Bundle for Optimization of Procedural Sedation for Newborns Undergoing Magnetic Resonance Imaging: A Single-Center Quality Improvement Project in Qatar

Daoud,

Karayil Mohammad Ali,

Chakkarapani

et al. 2024

Biomed Hub

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Introduction: Magnetic resonance imaging (MRI) is a common procedure in tertiary care neonatal intensive care units (NICUs). MRIs aid in detailing structural anatomy and are increasingly utilized for prognostication. Keeping babies calm and motion-free in the MRI suite is challenging, and various approaches have been adopted to obtain the best image quality. We share our experience of intervention bundle for procedural sedation with the novel use of buccal midazolam in our NICU for babies undergoing MRI. Methods: This single-center quality improvement project comprised two epochs. Epoch 1 from April 2018 to December 2020 provided baseline data regarding sedation use and helped identify causes for suboptimal images and the adverse event rate. Following the implementation of an interventional bundle comprising specific midazolam dose recommendations tailored to background risk factors and streamlining the procedural sedation process, similar comparative data were collected in epoch 2 (May 2021 to December 2022) after a washout period. Results: Of 424 patients, 238 and 108 had MRI done under either procedural sedation protocol or feed and wrap technique in epoch 1 and 2, respectively. After excluding babies whose MRIs were performed under sedative infusions, 30 (13%) babies had adverse events in epoch 1, while only 8 (7%) events occurred in epoch 2. There was also a 37% improvement in the documentation of procedural sedation between the two epochs. Conclusion: Procedural sedation with buccal midazolam under neonatologist supervision is safe, efficient, and effective in babies undergoing MRI in this single-center study. More extensive studies may be warranted to assess the suitability of this sedation modality for broader use.

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Neuroimaging at Term Equivalent Age: Is There Value for the Preterm Infant? A Narrative Summary

Cited by 6 publications

References 174 publications

Implementation of the Feed and Swaddle Technique as a Non-Pharmacological Strategy to Conduct Brain Magnetic Resonance Imaging in Very Low Birth Weight Infants

Implementation of the Feed and Swaddle Technique as a Non-Pharmacological Strategy to Conduct Brain Magnetic Resonance Imaging in Very Low Birth Weight Infants

Development and Validation of MRI-based Brain Volumetry Model Predicting Poor Psychomotor Outcomes in Preterm Neonate

Intervention Bundle for Optimization of Procedural Sedation for Newborns Undergoing Magnetic Resonance Imaging: A Single-Center Quality Improvement Project in Qatar

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