- Neuroimaging in the term neonates with neonatal encephalopathy (NE) is useful to identify patterns consistent with hypoxic-ischemic brain injury, to inform management decisions, to prognosticate long-term outcome, and to rule out other etiologies than hypoxic- ischemic brain injury.
- Magnetic resonance imaging is the preferred imaging technique for examining the brain of term neonates with NE. Sequences should include at least T1- and T2-weighted sequences, DWI with ADC maps, and MRS.
- An early MRI (days 2–5 of life) is recommended for diagnosis and prognosis. MRI during TH may be especially beneficial to inform the direction (or possible redirection) of care, even though the full extent of brain injury may not yet be visible, while MRI immediately after TH may be more practical in routine clinical practice.
- Repeat MRI is recommended at days 10–14 of life when clinical concerns persist, including discrepancies between the early neuro- imaging findings and the clinical condition of the neonate.
- Early ultrasound may be useful during the first day of life as a screening tool to rule-out major intracranial hemorrhage and to assess for lesions of antenatal onset or abnormalities suggestive of NE mimics.
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