Recommendations for the use of brain MRI in the neonatal period

Magnetic resonance imaging (MRI) of the brain is a key tool in the diagnosis and prognosis of neurological conditions in newborn infants, especially when used along cranial ultrasound (cUS). Although its use has increased over the last decade, significant variations in protocols between centers persist. This document, developed by the Spanish Neonatal Brain Group in collaboration with pediatric neuroradiologists, establishes recommendations based on scientific evidence and clinical experience to standardize its use. The document describes the logistics of neonatal MRI, including patient preparation, image acquisition, and condition-specific protocols. Clinical indications and optimal timing of MRI are outlined to maximize its diagnostic and prognostic value in different pathologies such as hypoxic-ischemic encephalopathy, metabolic encephalopathy, arterial infarction, venous sinus thrombosis, congenital infections and brain damage associated with hypoglycemia, hyperbilirubinemia or prematurity. Condition-specific patterns of damage and their prognostic correlation are described. The document offers recommendations for the standardization of radiological reports and the reporting of critical findings to improve communication between radiologists, clinicians and parents. In conclusion, these recommendations aim to optimize the use of brain MRI in neonatology, which will result in improved diagnostic accuracy and better-informed therapeutic decision-making, with the ultimate goal of improving neurodevelopmental outcomes in this vulnerable population.