Understanding the Impact of Neuroimaging in Critically Ill Newborns

Many people would be surprised to learn that premature babies with possible brain injury frequently get different diagnostic testing than babies who are born near their term due date. Neonatologist Dr. Paul Mann has seen this firsthand in his clinical practice, and wants to find out if his experience is representative of what was happening nationally.

For nearly 40 years, head ultrasound has been the main test used to predict neurodevelopmental outcomes for premature infants during their hospitalization. Magnetic resonance imaging (MRI), a more precise brain-imaging test, frequently is used as a diagnostic tool for term infants, but is used sparingly for preemies. This is especially true in the first weeks of life for premature infants, when critical decisions often need to be made. Mann wondered if these differences are justified. As a Bioethics faculty member, he wanted to explore why these approaches to diagnosing brain injury can be vastly different in two populations of infants.

To learn more, he designed a longitudinal survey to look at brain imaging studies of premature babies born less than 32 weeks old. With Drs. Benjamin Wilfond, Sid Gospe, Sunny Juul and David Woodrum, he is analyzing the potential benefits and harms of trying to predict neurodevelopmental outcomes in this population of premature infants.

For many parents of premature infants, tough decisions must be made regarding how much medical intervention they want at different points during hospitalization. These decisions come at a time of extreme emotion and exhaustion. There are lots of things to consider, and the stakes are high. Being born premature has many risks, including the possibility of neurodevelopmental impairments such as cerebral palsy.

This is the first study to ask for parents’ input to help better understand how different imaging methods affect parents’ views of their baby when making difficult choices, including continuing or withdrawing life supportive care.

“We need to check the assumption that neonatal neuroimaging is a beneficial practice for all parents and be honest about the outcomes these tests can and cannot accurately predict. This will change the dialog between parents and providers to more broadly reflect the information that different parents are looking for about their babies.”

Dr. Paul Mann

To learn more, read Fuzzy Images: Ethical Implications of Using Routine Neuroimaging in Premature Neonates to Predict Neurologic Outcomes. Pediatrics August 2013;163 (2):587–592.

Ultimate Goal

To better reflect parents’ wishes regarding use of technology to predict their infant’s neurodevelopment.