Myth: cerebral palsy cannot be predicted by neonatal brain imaging

Area of Science:

• Neonatal Neurology
• Pediatric Radiology
• Neurodevelopmental Pediatrics

Background:

• Controversy exists regarding the predictive value of neonatal brain imaging for cerebral palsy (CP).
• Accurate prediction of CP is crucial for timely intervention and improved outcomes in high-risk infants.

Purpose of the Study:

• To evaluate the role of neonatal neuroimaging in predicting cerebral palsy (CP).
• To clarify the myth that neuroimaging cannot predict CP in neonates.

Main Methods:

• Review of sequential cranial ultrasound findings in preterm infants.
• Assessment of magnetic resonance imaging (MRI) at term-equivalent age, focusing on myelination.
• Evaluation of MRI, including diffusion-weighted imaging, for predicting motor outcomes in term infants with hypoxic-ischaemic encephalopathy or neonatal stroke.

Main Results:

• Sequential cranial ultrasound can identify major intracranial lesions predicting non-ambulatory CP in preterm infants.
• MRI at term-equivalent age refines CP prediction by assessing internal capsule myelination.
• Predicting motor outcomes in preterm infants with subtle white matter injury remains challenging, even with conventional MRI.
• MRI, particularly with diffusion-weighted imaging, is a valuable tool for predicting outcomes in term infants with neonatal brain injury.

Conclusions:

• Neonatal neuroimaging, when used sequentially and dedicatedly, can effectively predict motor outcomes in high-risk newborns.
• Cranial ultrasound and MRI are essential tools for predicting cerebral palsy and guiding management in neonates.