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Neonatal brain magnetic resonance imaging: clinical indications, acquisition and reporting
  1. Topun Austin1,2,
  2. Daniel Connolly3,
  3. Kate Dinwiddy4,
  4. Anthony Richard Hart5,
  5. Axel Heep6,
  6. Sundeep Harigopal7,
  7. Harriet Joy8,
  8. Karen Luyt9,
  9. Christina Malamateniou10,
  10. Nazakat Merchant11,
  11. Chrysoula Rizava12,
  12. Mary A Rutherford13,
  13. Kelly Spike14,
  14. Brigitte Vollmer15,16,
  15. James P Boardman17
  1. 1 Neonatal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  2. 2 University of Cambridge, Cambridge, UK
  3. 3 Department of Neuroradiology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
  4. 4 British Association of Perinatal Medicine, Royal College of Paediatrics and Child Health, London, UK
  5. 5 Paediatric Neurology, King's College London, London, UK
  6. 6 University of Bristol Medical School, Bristol, UK
  7. 7 Neonatal Intensive Care, Royal Victoria Infirmary, Newcastle upon Tyne, UK
  8. 8 Department of Neuroradiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  9. 9 Bristol Medical School, University of Bristol, Bristol, UK
  10. 10 Department of Midwifery and Radiography, City University of London, London, UK
  11. 11 Neonatal Unit, Watford General Hospital, Watford, UK
  12. 12 Sheffield Children's Hospital, Sheffield, UK
  13. 13 Division of Imaging Sciences, King's College London, London, UK
  14. 14 Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  15. 15 Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK
  16. 16 Neonatal and Paediatric Neurology, Southampton Children's Hospital, Southampton, UK
  17. 17 Institute for Regeneration and Repair, University of Edinburgh Division of Reproductive and Developmental Sciences, Edinburgh, UK
  1. Correspondence to Dr Topun Austin, Neonatal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; ta338{at}cam.ac.uk

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Collaborators

This framework for practice was developed by the British Association of Perinatal Medicine and British Society of Neuroradiologists and has been endorsed by the British Paediatric Neurology Association and the Society of Radiographers.

Terms of reference, audit standards and early notification scheme

MRI has become increasingly available to clinicians to evaluate the newborn. However, with the exception of MRI in term infants with hypoxic-ischaemic encephalopathy (HIE), there are no formal guidelines that address the clinical indications for and the practical aspects of MRI of the brain in this patient group within the National Health Service (NHS).

Terms of reference

The purpose of this framework is to:

  • Provide recommendations on clinical indications for and timing of neonatal brain MRI.

  • To promote best practices for acquiring and reporting neonatal brain MRI.

The roles of MRI in postmortem examination, fetal imaging and perinatal research are beyond the scope of this document, as are detailed sequence parameter recommendations for image acquisition on specific scanners.

The recommendations for scanning in this document are based on the use of 1.0 T and 3.0 T scanners; while ultra-low field, low field and ultra-high field scanners are available, they are not currently in widespread clinical use.

Recommendations for best practice

MR scanning of the newborn should be undertaken in a facility with radiographers experienced in examining this patient group. Radiologists with subspecialty training in paediatric radiology and/or neuroradiology should report these images. A network or regional approach and multidisciplinary team (MDT) review can facilitate this.

Audit standards

  1. Infants born at term (≥37 weeks’ gestational age (GA)) with acquired brain injury, neonatal encephalopathy (NE) and/or seizures should undergo MRI, which is the imaging modality of choice. For prognostic and diagnostic purposes, the optimal timing for image acquisition in cases of HIE is between 4 and 14 days after birth. In newborn infants with NE and/or seizures in whom HIE is not suspected, MRI should not be delayed …

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Footnotes

  • Twitter @KarenLuyt, @Naazmerchant

  • Correction notice This paper has been corrected since it was first published. We have corrected author Brigitte Vollmer's first name.

  • Collaborators British Association of Perinatal Medicine, British Paediatric Neurology Association, British Society of Neuroradiologists, Society of Radiographers.

  • Contributors All of the authors attended at least one Working Group meeting and contributed to the writing and editing of the Framework for Practice. TA: chaired the Working Group and wrote the first and all subsequent drafts of the article and approved the final version. JPB contributed significantly to the drafting and final version of the article and approved the final manuscript. DC, KD, ARH, AH, SH, HJ, KL, CM, CR, KS and BV contributed significantly to the drafting of the article and subsequent edits and approved the final manuscript. NM contributed significantly to the drafting of the article and subsequent edits, formatted the references and approved the final manuscript. MAR contributed significantly to the drafting of the article, provision of table and figures and subsequent edits and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.