Mayur__Kumar

There is almost nothing as challenging and stressful as having a premature baby in the NICU. Even if you know your baby is receiving the best medical care out there, you can’t help but be overwhelmed with worry.

If your baby is unwell, when will they get better? If your baby is healthy, will they stay that way? Will they contract an infection in the NICU? Will they grow properly and gain strength? Will they reach their milestones on the same timeline as other babies? And what about their future? Will they have disabilities or medical issues associated with their prematurity?

These worries and fears are common among NICU parents. Yet there is reason for optimism.

Still, you likely have many questions as your baby receives care in the NICU, including the many procedures and tests your baby must undergo before they are ready for release. 

MRIs and Premature Babies

During your baby’s NICU stay, they will receive a battery of tests so that their care team can ensure the health and safety of your baby. Some of these tests are routine, and others may be specific to your baby’s particular medical conditions or needs. The tests will help your baby’s care team decide what medical treatments your baby needs, and will help them to understand their overall health.

Most of the major tests will require your consent. Your healthcare team will explain each procedure to you and have you sign a consent form if needed before performing the procedure.

Common diagnostic tests performed on premature babies include:

• Blood tests: Various blood tests will be performed on your baby. For example, your baby may be checked for anemia.
• CT scan (computed tomography scan): This test allows your provider to see 3D images inside your baby’s body. Your baby may need to be sedated for this procedure.
• EKG, ECG, and echocardiogram: These tests provide information about the health of your baby’s heart.
• Hearing test: As part of the newborn screening, your baby will get a hearing test.
• Newborn screening test: This is a test all babies receive, whether full-term or premature. The newborn screening includes blood tests, hearing tests, and a heart screening, and looks for common newborn health conditions.
• ROP exam (retinopathy of prematurity): This is an eye exam performed by an ophthalmologist to check the health of your baby’s eyes.
• Ultrasound: During an ultrasound, gel will be spread on your baby’s body and an ultrasound wand will be used to pick up sound waves, which provide images of your baby’s body. Ultrasounds of preemies are often used to check for brain bleeding.
• Urine tests: Urine tests check the health of your baby’s kidneys, as well as other bodily functions. They are also used to check for infections.
• X-rays: X-rays use minimal amounts of radiation to create images of the inside of your baby’s body. X-rays in preemies are often used to detect lung issues.

Why a Preemie Might Get an MRI

MRIs are another test that your baby may or may not get in the NICU. An MRI test can give a more detailed view of the inside of your baby’s body than ultrasounds, CT scans, or X-rays can. Unlike X-rays, MRIs don’t use radiation to create these images. Instead, MRIs use magnetic fields, magnetic field gradients, and radio waves to create images of your baby’s organs. 

MRIs for preemies are not routine at all hospitals, and are usually ordered only when there is a specific reason or concern. For example, if your doctor suspects a brain bleed but isn’t getting conclusive results from an ultrasound, they may order an MRI.

Another reason that your doctor may want to perform an MRI on your premature baby is to understand what developmental disabilities your baby may face in the future, as there is evidence that MRI brain scans can give healthcare providers vital data about your baby’s risk of cognitive, behavioral, and motor delays later in childhood.

It should be noted, however, that the Academy of American Pediatrics (AAP) does not recommend the routine use of MRIs for premature babies, stating that, “An MRI can't really tell you how your child's brain will develop over time, especially if the test is abnormal.” Instead, they recommend that your baby’s brain development be monitored over time by your pediatrician.

Are MRI Scans Safe for Preemies?

The safety of MRIs for premature babies will vary from one baby to another, and your baby’s doctor is the best judge of whether performing the test is safe or appropriate for your baby. MRIs require your baby to be placed in a large, loud, and cold machine, which can be difficult on a little, vulnerable body.

There have been many renovations in terms of MRI technology for premature babies, but the procedure is not without risk. For example, a study published in Pediatric Radiology found that “minor adverse events” are common after MRIs for premature babies, including respiratory instability and hypothermia.

What to Expect

Before your baby gets an MRI, your doctor will describe the procedure in full to you and have you sign a form of consent. You should feel free to ask any questions you may have about the procedure, including its purpose and potential side effects.

The MRI will typically take place in the hospital’s MRI center, a radiofrequency shielded room. However, some hospitals are now using MRI machines that are located in the NICU so that your baby doesn’t have to be transported far. These MRI machines also use a “temperature-controlled infant incubator,” which your baby will be placed in so that their temperature can stay stable during the procedure.

Predicting Future Disability

One of the main reasons that MRIs are used for premature infants is to help predict future disability, so that a plan of care and appropriate interventions can be put into place early in your baby’s life.

Although there have been debates about how helpful it can be to perform MRIs for this purpose during your baby’s NICU stay, a study from 2017 showed that this procedure may be quite beneficial in certain circumstances.

The study published in the January 2017 issue of Neurology, the journal from the American Academy of Neurology, found that performing an MRI scan of a premature baby’s brain soon after birth can reveal areas of “white matter” in the brain, which is predictive of later disabilities.

A 2017 press release from the American Academy of Neurology explained that the most common brain injury among premature infants results from a lack of oxygen to the brain, producing these patches of “white matter” on the brain.

“White matter contains nerve fibers that maintain contact between various parts of the brain,” the press release read. “Damage to white matter can interfere with communication in the brain and the signals it sends to other parts of the body.”

The study researchers surveyed a group of premature infants who had been admitted to Neonatal ICU at British Columbia’s Women’s Hospital over the course of seven years. 58 of these infants were given MRIs at about 32 weeks which revealed signs of “white matter” injury. At 18 months old, these babies were evaluated for cognitive, motor, and language skills.

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