New research published in Anales de Pediatría offers a comprehensive framework for when and how to use brain magnetic resonance imaging (MRI) in newborns. The guidelines aim to standardize neonatal MRI practices, which currently vary widely across centers, despite the growing accessibility of the technology.
While the guidance applies broadly to infants with suspected brain injury, it has particular relevance for conditions like fetal and neonatal alloimmune thrombocytopenia (FNAIT), in which intracranial hemorrhage and subtle brain injury can occur before or shortly after birth. Current FNAIT management protocols typically recommend an ultrasound to detect bleeding, but MRI can provide much higher spatial resolution and can detect much smaller or brain injuries that an ultrasound might miss.
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The new guidance explains that MRI should be considered when a baby shows neurological symptoms such as seizures, low muscle tone or signs of encephalopathy, or when an ultrasound scan raises questions about possible brain injury. MRI provides a much clearer and more detailed image of the brain, allowing doctors to see areas of bleeding, tissue damage or changes in white matter that might affect future development.
Concerning FNAIT, these recommendations highlight how MRI can play an important role not only in confirming or ruling out bleeding but also in detecting subtle, hidden injuries that could affect long-term outcomes. Even when bleeding has been prevented through antenatal treatment, an MRI can help reassure families and guide follow-ups.
The authors recommend using MRI scanners designed for newborns and special techniques, such as wrapping and feeding the baby before the scan, to minimize movement and avoid the need for sedation. They also stress the importance of clear, standardized reporting so that results are interpreted consistently and shared effectively among care teams.
“Brain MRI is a crucial tool for the diagnosis and prognosis of neonatal neurologic disorders,” the researchers concluded. “The use of standardized protocols and a thorough understanding of image interpretation are essential to improving care and outcomes in affected infants.”
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