Monitoring the neonatal brain: a survey of current practice among Australian and New Zealand neonatologists

AIMS: There is considerable variation in the use of brain imaging and electrophysiological monitoring of encephalopathic term infants. The aims of this study were (i) to document the current practice among Australian and New Zealand neonatologists; and (ii) to identify the factors that influence local practice. METHODS: A postal questionnaire was sent to all 152 neonatologists in Australia and New Zealand. A hypothetical scenario of an encephalopathic term infant was presented and clinicians were asked a series of questions relating to their use of magnetic resonance imaging (MRI), computed tomography, ultrasound, electroencephalography and amplitude integrated electroencephalography. RESULTS: There was a 62% response rate. Twenty-two per cent of respondents would not routinely perform an MRI brain scan in the given scenario. Limited availability, expense, logistics of transport and a lack of confidence in the ability of MRI to provide additional clinical information appear to be the main factors affecting practice. When a scan is performed, the majority of respondents (72%) perform the scan on day 5 or later. Twenty-three per cent of respondents experience significant delays when they request an MRI scan. Regarding electrophysiological monitoring, amplitude integrated electroencephalography would be used by 62% of respondents in the given scenario. CONCLUSIONS: This study demonstrates that MRI is now widely used by neonatologists in Australia and New Zealand. However, local resource limitations and a lack of confidence in the utility of MRI continue to limit its use.