Magnetic Resonance Imaging (MRI) and Prognostication in Neonatal Hypoxic-Ischemic Injury

Author:

Bell Emily1,Rasmussen Lisa Anne2,Mazer Barbara3,Shevell Michael2,Miller Steven P.4,Synnes Anne5,Yager Jerome Y.6,Majnemer Annette2,Muhajarine Nazeem7,Chouinard Isabelle1,Racine Eric128

Affiliation:

1. Institut de recherches cliniques de Montréal, Montreal, Quebec, Canada

2. McGill University, Montreal, Quebec, Canada

3. Jewish Rehabilitation Hospital of Laval, Laval, Quebec, Canada

4. University of Toronto, Toronto, Ontario, Canada

5. University of British Columbia, Vancouver, British Columbia, Canada

6. University of Alberta, Edmonton, Alberta, Canada

7. University of Saskatchewan, Saskatoon, Saskatchewan, Canada

8. Université de Montréal, Montréal, Quebec, Canada

Abstract

Magnetic resonance imaging (MRI) could improve prognostication in neonatal brain injury; however, factors beyond technical or scientific refinement may impact its use and interpretation. We surveyed Canadian neonatologists and pediatric neurologists using general and vignette-based questions about the use of MRI for prognostication in neonates with hypoxic-ischemic injury. There was inter- and intra-vignette variability in prognosis and in ratings about the usefulness of MRI. Severity of predicted outcome correlated with certainty about the outcome. A majority of physicians endorsed using MRI results in discussing prognosis with families, and most suggested that MRI results contribute to end-of-life decisions. Participating neonatologists, when compared to participating pediatric neurologists, had significantly less confidence in the interpretation of MRI by colleagues in neurology and radiology. Further investigation is needed to understand the complexity of MRI and of its application. Potential gaps relative to our understanding of the ethical importance of these findings should be addressed.

Publisher

SAGE Publications

Subject

Clinical Neurology,Pediatrics, Perinatology, and Child Health

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