American Academy of Pediatrics – Section on Perinatal Pediatrics

View all recommendations from this society

Released July 20, 2015

Avoid routine screening term-equivalent or discharge brain MRIs in preterm infants.

Findings on term-equivalent magnetic resonance imaging (MRI) correlate with neurodevelopmental outcomes at discharge and at 2 and 5 years of age. There is, however, insufficient evidence that the routine use of term-equivalent or discharge screening brain MRIs in preterm infants improves long-term outcome.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Academy of Pediatrics Section on Perinatal Pediatrics (SoPPe) Executive Committee employed a national survey of representative newborn medicine providers from SoPPe and the Vermont-Oxford Network. Survey recipients were asked to consider the range of testing and treatments conducted on high and low risk newborns. They were then asked them to provide examples of tests and treatments that, in their opinion, best met any or all of the following criteria: there is evidence of lack of efficacy, there is insufficient evidence of efficacy, or the test or treatment unnecessarily utilized staffing or material resources. Among the recipients, 1047 responded with a total of 2870 suggestions of tests and treatments. These responses were then collated and presented to an expert panel of 51 individuals representing 28 national and regional stakeholder perinatal care organizations. A modified Delphi process utilizing electronic survey techniques was used to narrow the list to the Top 5 over three rounds. During the initial round, the panel reduced the top 22 general categories of tests and treatments to 13. The reintroduction of specific clinical contexts, derived from the original survey, resulted in 24 items that were reduced to 12 in the second round. In the final round, the panel was provided with GRADE (Grades of Recommendation, Assessment, Development and Evaluation) literature summaries of the top 12 to ensure that all current evidence was considered. The final list was reviewed and approved by the Academy’s Board of Directors and Executive Committee.

AAP’s disclosure and conflict of interest policy can be found at www.aap.org.

Sources

Iwata S, Nakamura T, Hizume E, Kihara H, Takashima S, Matsuishi T, Iwata O. Qualitative brain MRI at term and cognitive outcomes at 9 years after very preterm birth. Pediatrics. 2012 May;129(5):e1138-47.

Janvier A, Barrington K. Trying to predict the future of ex-preterm infants: who benefits from a brain MRI at term? Acta Paediatr. 2012 Oct;101(10):1016-7.

Miller SP, Ferriero DM, Leonard C, Piecuch R, Glidden DV, Partridge JC, Perez M, Mukherjee P, Vigneron DB, Barkovich AJ. Early brain injury in premature newborns detected with magnetic resonance imaging is associated with adverse early neurodevelopmental outcome. J Pediatr. 2005 Nov;147(5):609-16.

Nongena P, Ederies A, Azzopardi DV, Edwards AD. Confidence in the prediction of neurodevelopmental outcome by cranial ultrasound and MRI in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2010 Nov; 95(6):F388-90.

Pearce R, Baardsnes J. Term MRI for small preterm babies: do parents really want to know and why has nobody asked them? Acta Paediatr. 2012 Oct;101(10):1013-5.

Setänen S, Haataja L, Parkkola R, Lind A, Lehtonen L. Predictive value of neonatal brain MRI on the neurodevelopmental outcome of preterm infants by 5 years of age. Acta Paediatr. 2013 May;102(5):492-7.

Woodward LJ, Anderson PJ, Austin NC, Howard K, Inder TE. Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. N Engl J Med. 2006 Aug 17; 355(7):685-94.

Woodward LJ, Clark CA, Bora S, Inder TE. Neonatal white matter abnormalities an important predictor of neurocognitive outcome for very preterm children. PLoS One. 2012;7(12):e51879.