MRI at discharge for the former ELBW

Posted July 30, 20195 yr

HI!!!

My group is putting together guidelines to use with the ELBW and one of the questions that has come up is the use of MRI at discharge for the former ELBW. We do not have pediatric neuroradiologists at our institution so have not had very useful reports obtained when we have ordered these studies. That being said I was still wondering what folks are doing out there regarding this topic. The literature is quite conflicting. Thanks for any insight!

Char Crichton

July 31, 20195 yr

Dear Char, you would have loved to attend this lecture at the latest #99nicuMeetup, and participate in the debate that followed. Complex topic!

August 3, 20195 yr

Given that ELBWs get comprehensive follow-up (at least in most settings I know where you could even contemplate routine MRI at discharge), what possible value could MRI provide which would change care or outcomes? Would you stop following up ELBWs who you 'knew' by imagining criteria were not going to have CP? I doubt it, because you'd want to see them anyway for other developmental reasons. Do you have an intervention which can prevent CP after NICU discharge? I don't. The best you can say about a routine MRI protocol is that you could tell the parents on graduation the probability of their child developing CP. That prediction is only reasonably reliable for a 'normal' study and in either case isn't really much better with MRI than with US.

Maybe this will change with research, but I'm pessimistic. Research will probably make imaging a better research tool and inform our understanding of brain development and injury, but the clinical utility of making predictions at NICU graduation, in the absence of some sort of specific post-discharge intervention, seems dubious at best.

August 8, 20195 yr

On 8/3/2019 at 7:27 AM, bimalc said:

Given that ELBWs get comprehensive follow-up (at least in most settings I know where you could even contemplate routine MRI at discharge), what possible value could MRI provide which would change care or outcomes?

As I understand it, MRI is better at detecting who will NOT develop severe developmental abnormalities, so that might be of comfort to parents. But as so often - very few things are black and white...