Predictive value of brain MRI for neurodevelopmental outcome in infants with severe unconjugated hyperbilirubinemia: A systematic review.

Debate exists regarding predictive value of brain MRI for long-term neurodevelopmental outcome (NDO) in infants with severe unconjugated hyperbilirubinemia (above exchange transfusion levels). To investigate whether MRI findings among (pre-)term infants with severe unconjugated hyperbilirubinemia can predict NDO at ≥ 12 months and determine optimal timing for MRI. PubMed and Embase. Last update: June 14, 2024. Studies in which (pre-)term infants with severe unconjugated hyperbilirubinemia who underwent an MRI before 24 months and had a reported NDO at ≥ 12 months were included. Patient characteristics, MRI and NDO details were extracted. The search yielded 732 studies, of which 22 were included. Individual patient information was obtained for 120 infants (MRI-timing: early (≤6 weeks) n = 75, late (>6 weeks) n = 19, unknown n = 26). Positive predictive value (PPV) of abnormal MRI in the total group for impaired NDO was high (77.5 %). The PPV of late compared to early MRI was much higher, 92.3 % versus 71.7 %. Negative predictive value of normal MRI for normal NDO in the total group was low (29.0 %) and again higher in late compared to early MRI, 50.0 % versus 27.3 %. Quantitative synthesis of results was impossible due to large heterogeneity in study designs. Furthermore, selection bias towards patients with impaired outcome might have influenced our results. Brain MRI can serve as prognostic tool for NDO in infants with severe unconjugated hyperbilirubinemia, both in early and late stages, but each timing has inherent constraints. Further prospective studies are necessary. • This systematic review uniquely evaluates the predictive value of brain MRI for neurodevelopmental outcomes in neonates with severe unconjugated hyperbilirubinemia (above exchange transfusion levels). • Late MRIs (conducted >6 weeks postnatally) demonstrate a significantly higher predictive value for impaired neurodevelopmental outcomes compared to early MRIs (conducted ≤6 weeks postnatally). • The high percentages in reported studies (75.8 %) of infants with adverse neurological outcomes after severe unconjugated hyperbilirubinemia suggest selection bias, may also be due to the wide NDO range and are not fully representative of the broader patient population. • There is a notable lack of large, prospective studies assessing the predictive value of MRI in neonatal severe unconjugated hyperbilirubinemia. [ABSTRACT FROM AUTHOR]