COMMENTARY Trying to predict the future of ex-preterm infants: who benefits from a brain MRI at term? Annie Janvier (anniejanvier@hotmail.com; annie.janvier.hsj@ssss.gouv.qc.ca), Keith Barrington Department of Pediatrics, Universite ´ de Montre ´ al, Ho ˆ pital Sainte-Justine, Montreal, Quebec Keywords Family well-being, Follow-up studies, Magnetic resonance imaging, Prematurity, Prognostic value Correspondence Annie Janvier, M.D., Ph.D., Department of Pediatrics and Clinical Ethics, University of Montreal, 3175 Chemin Co ˆ te-Sainte-Catherine, Montreal, H3T 1C5 Quebec. Neonatologist and Clinical Ethicist, Sainte-Justine Hospital, 3175 Chemin Co ˆ te-Sainte-Catherine, Mon- treal, H3T 1C5 Quebec. Tel: +514 345 4931, ext 3305 | Fax: +514 345 4822 | Emails: anniejanvier@hotmail.com; annie.janvier.hsj@ssss.gouv.qc.ca Received 13 July 2012; accepted: 13 July 2012. DOI:10.1111/j.1651-2227.2012.02788.x In this issue of the journal, Jason Baardness and Rebecca Pearce (1) discuss their trying experience as the parents of 25 week twins. Lily died after 7 days of NICU stay, and Ma- ren had a very complicated course. We took care of their two daughters. Like most parents, they wanted to be informed about the chances of survival of their children and their potential long-term consequences. We remember counselling them during their daughters’ stormy course. Unlike most parents, they have both scientific backgrounds and understand statistics very well. We remember telling them that medical publications only gave probabilities and we could not predict with much certainty what would hap- pen to their daughter; Maren was there, and she was the one who would eventually answer with absolute precision all of their questions about her long-term outcome. There are a number of potentially appropriate indications to perform investigations just before discharge which are designed to predict future neurological or developmental outcomes of preterm babies: (i) to focus follow-up pro- grammes; (ii) to select babies for early intervention pro- grammes; (iii) to do quality control; (iv) to prepare parents for the future; (v) and for research to better understand the effects of prematurity on the brain. Is the term equivalent age cerebral magnetic resonance imaging (MRI) an appro- priate tool for these purposes? A normal term MRI has a high negative predictive value (NPV) for cerebral palsy, but a much lower NPV for developmental delay (2,3). An abnor- mal MRI is much more troublesome, although there may be a statistically significant association with adverse outcomes, the positive predictive value (PPV) of most findings, for either cerebral palsy or developmental delay, in numerous studies is below 50%, (2) and in some studies as low as 10% (4). With such a low PPV, how much does it really help to know the results of a term MRI for a specific baby? The predictive values are really not adequate to deny fol- low-up to those with normal scans nor to select patients to participate in early intervention programmes (5,6). If the term MRI is being performed as a screening test, it does not satisfy the WHO criteria for such a test. Does changing the probabilities with the MRI really help parents prepare for the future? Instead of knowing – for a 25-week infant like Maren – before the test that your baby has a statistical 20% risk of ‘major’ disability and 35% of ‘minor’ disability, and a 50% chance of not being disabled, after the test you learn that your baby has either a 30% or a 65% risk of disability, depending on the findings. Do such adjustments in risk esti- mates help parents? Neonatologists have a great deal of Invited Commentary for Pearce and Baardsnes, Term MRI for small preterm babies: do parents really want to know and why has nobody asked them? pages 1013–1015. Abbreviations 3D, Three dimension; CGH, Complete genome hybridization; MRI, Magnetic resonance imaging; NICU, Neonatal intensive care unit; NPV, Negative predictive value; PPV, Positive predic- tive value. Acta Pædiatrica ISSN 0803–5253 1016 ª2012 The Author(s)/Acta Pædiatrica ª2012 Foundation Acta Pædiatrica 2012 101, pp. 1016–1017