Will my baby walk?
The predictive value of cranial imaging
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When a previously uncomplicated pregnancy unexpectedly “goes wrong” and a baby is severely asphyxiated, among the parents' first thoughts are, “Will my baby die?” and “If my baby lives, will she be okay?” Often it is the pediatrician or neonatologist to whom these questions are first directed, but ultimately the neurologist is often consulted. How should one answer these questions? What information is available to help prognosticate?
Martinez-Biarge et al.,1 in this issue of Neurology®, present data suggesting that a neonatal MRI in term infants with hypoxic-ischemic encephalopathy (HIE) may be helpful in predicting death and the severity of motor impairment. Unfortunately, neither cranial images nor any other test that we now have can help us answer parents' questions with any degree of certainty in the vast majority of cases.2 Foremost in most parents' minds is their concern that the perinatal insult may have an indelible effect on their baby. They worry both about immediate suffering and about the long-term implications, so generalized probabilities are likely to have only limited value for them. In …
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