Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Ten-year trends in infant neuroimaging from US Neonatal Intensive Care Units

Journal of Perinatology volume 40, pages 1389–1393 (2020)Cite this article

Subjects

Abstract

Objective

To identify patterns of neuroimaging (NI), including cranial ultrasounds (CUS) and magnetic resonance imaging (MRI), among a large cohort of United States NICU infants.

Study design

The retrospective cohort study of the Pediatrix Clinical Data Warehouse for infants discharged between 2008 and 2017.

Results

From the 863,863 infants during the study period, 204,197 (24%) had at least one NI study. CUS was the most common study (n = 189,190, 22%) followed by MRI (n = 37,107, 4%). From 2008 to 2017, the percentage of infants who underwent any NI decreased from 28 to 21% (p < 0.001) driven primarily by a reduction in CUS. MRI use for infants ≤33 weeks increased through 2015 and then decreased.

Conclusions

Overall reductions in NI have been driven by decreased use of CUS in infants born at 31–33 weeks’ gestational age. MRI use among preterm infants has been more dynamic with an initial rise and recent decrease.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Barnes PD. Neuroimaging and the timing of fetal and neonatal brain injury. J Perinatol. 2001;21:44–60.

    Article  CAS  Google Scholar 

  2. Neil JJ, Inder TE. Imaging perinatal brain injury in premature infants. Semin Perinatol. 2004;28:433–43.

    Article  Google Scholar 

  3. Hintz SR, O’Shea M. Neuroimaging and neurodevelopmental outcomes in preterm infants. Semin Perinatol. 2008;32:11–9. https://doi.org/10.1053/j.semperi.2007.12.010.

    Article  PubMed  Google Scholar 

  4. Ment LR, Bada HS, Barnes P, et al. Practice parameter: neuroimaging of the neonate: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2002;58:1726–38.

    Article  CAS  Google Scholar 

  5. Neuroimaging of the Neonate. Am Acad Neurol. 2018. https://www.aan.com/Guidelines/Home/GuidelineDetail/78. Accessed July 30, 2019.

  6. Ho T, Dukhovny D, Zupancic JA, Goldmann DA, Horbar JD, Pursley DM. Choosing wisely in newborn medicine: five opportunities to increase value. Pediatrics. 2015;136:e482–9. https://doi.org/10.1542/peds.2015-0737.

    Article  PubMed  Google Scholar 

  7. Spitzer AR, Ellsbury DL, Handler D, Clark RH. The Pediatrix BabySteps Data Warehouse and the Pediatrix QualitySteps improvement project system—tools for “meaningful use” in continuous quality improvement. Clin Perinatol. 2010;37:49–70. https://doi.org/10.1016/j.clp.2010.01.016.

    Article  PubMed  Google Scholar 

  8. Natarajan G, Shankaran S, Saha S, Laptook A, Das A, Higgins R, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. et al. Antecedents and outcomes of abnormal cranial imaging in moderately preterm infants. J Pediatr. 2018;195:66–72.e3. https://doi.org/10.1016/j.jpeds.2017.11.036.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Routine screening cranial ultrasound examinations for the prediction of long term neurodevelopmental outcomes in preterm infants. Paediatr Child Health. 2001;6:39–52. https://doi.org/10.1093/pch/6.1.39.

  10. Hintz SR, Vohr BR, Bann CM, Taylor HG, Das A, Gustafson KE, et al. Preterm neuroimaging and school-age cognitive outcomes. Pediatrics. 2018;142:e20174058. https://doi.org/10.1542/peds.2017-4058.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Woodward LJ, Anderson PJ, Austin NC, Howard K, Inder TE. Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. N Engl J Med. 2006;355:685–94.

    Article  CAS  Google Scholar 

  12. Horsch S, Skiöld B, Hallberg B, et al. Cranial ultrasound and MRI at term age in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed. 2010;95:F310–4. https://doi.org/10.1136/adc.2009.161547.

    Article  CAS  PubMed  Google Scholar 

  13. Hintz SR, Barnes PD, Bulas D. Support Study Group of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, et al. Neuroimaging and neurodevelopmental outcome in extremely preterm infants. Pediatrics.2015;135:e32–42. https://doi.org/10.1542/peds.2014-0898.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Slaughter LA, Bonfante-Mejia E, Hintz SR, Dvorchik I, Parikh NA. Early conventional MRI for prediction of neurodevelopmental impairment in extremely-low-birth-weight infants. Neonatology. 2016;110:47–54. https://doi.org/10.1159/000444179.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Rademaker KJ, Uiterwaal CS, Beek FJ, et al. Neonatal cranial ultrasound versus MRI and neurodevelopmental outcome at school age in children born preterm. Arch Dis Child Fetal Neonatal Ed. 2005;90:F489–93.

    Article  CAS  Google Scholar 

  16. Edwards AD, Redshaw ME, Kennea N, ePrime Investigators. et al. Effect of MRI on preterm infants and their families: a randomised trial with nested diagnostic and economic evaluation. Arch Dis Child Fetal Neonatal Ed. 2018;103:F15–21. https://doi.org/10.1136/archdischild-2017-313102.

    Article  PubMed  Google Scholar 

  17. Ou Y, Zöllei L, Retzepi K, Castro V, Bates SV, Pieper S, et al. Using clinically acquired MRI to construct age-specific ADC atlases: quantifying spatiotemporal ADC changes from birth to 6-year old. Hum Brain Mapp. 2017;38:3052–68. https://doi.org/10.1002/hbm.23573.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Parikh NA, Hershey A, Altaye M. Early detection of cerebral palsy using sensorimotor tract biomarkers in very preterm infants. Pediatr Neurol. 2019. pii: S0887-8994(19)30295-4. https://doi.org/10.1016/j.pediatrneurol.2019.05.001.

  19. Barnette AR, Horbar JD, Soll RF, et al. Neuroimaging in the evaluation of neonatal encephalopathy. Pediatrics. 2014;133:e1508–17. https://doi.org/10.1542/peds.2013-4247.

    Article  PubMed  Google Scholar 

  20. Ozturk A, Sasson AD, Farrell JA, Landman BA, da Motta AC, Aralasmak A, et al. Regional differences in diffusion tensor imaging measurements: assessment of intrarater and interrater variability. Am J Neuroradiol. 2008;29:1124–7. https://doi.org/10.3174/ajnr.A0998.

    Article  CAS  PubMed  Google Scholar 

  21. Goergen SK, Ang H, Wong F, Carse EA, Charlton M, Evans R, et al. Early MRI in term infants with perinatal hypoxic-ischaemic brain injury: interobserver agreement and MRI predictors of outcome at 2 years. Clin Radiol. 2014;69:72–81. https://doi.org/10.1016/j.crad.2013.09.001.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Dallas, TX, USA

    Veeral N. Tolia

  2. Pediatrix Medical Group, Dallas, TX, USA

    Veeral N. Tolia

  3. The Center for Research Education, Quality, and Safety, Mednax, Inc, Sunrise, FL, USA

    Veeral N. Tolia, Reese H. Clark, Dan L. Ellsbury & Kaashif Ahmad

  4. Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Timmy Ho & John A. F. Zupancic

  5. Department of Pediatrics, Baylor College of Medicine, San Antonio, TX, USA

    Kaashif Ahmad

  6. Pediatrix Medical Group, San Antonio, TX, USA

    Kaashif Ahmad

Authors
  1. Veeral N. Tolia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Reese H. Clark
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dan L. Ellsbury
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Timmy Ho
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John A. F. Zupancic
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kaashif Ahmad
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Veeral N. Tolia.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tolia, V.N., Clark, R.H., Ellsbury, D.L. et al. Ten-year trends in infant neuroimaging from US Neonatal Intensive Care Units. J Perinatol 40, 1389–1393 (2020). https://doi.org/10.1038/s41372-020-0667-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-020-0667-4

Search

Advanced search

Quick links