SUMMARY:Fetal and neonatal MR imaging is increasingly used as a complementary diagnostic tool to sonography. MR imaging is an ideal technique for imaging fetuses and neonates because of the absence of ionizing radiation, the superior contrast of soft tissues compared with sonography, the availability of different contrast options, and the increased FOV. Motion in the normally mobile fetus and the unsettled, sleeping, or sedated neonate during a long acquisition will decrease image quality in the form of motion artifacts, hamper image interpretation, and often necessitate a repeat MR imaging to establish a diagnosis. This article reviews current techniques of motion compensation in fetal and neonatal MR imaging, including the following: 1) motion-prevention strategies (such as adequate patient preparation, patient coaching, and sedation, when required), 2) motion-artifacts minimization methods (such as fast imaging protocols, data undersampling, and motion-resistant sequences), and 3) motion-detection/correction schemes (such as navigators and self-navigated sequences, external motion-tracking devices, and postprocessing approaches) and their application in fetal and neonatal brain MR imaging. Additionally some background on the repertoire of motion of the fetal and neonatal patient and the resulting artifacts will be presented, as well as insights into future developments and emerging techniques of motion compensation.ABBREVIATIONS: bFFE ϭ balanced fast-field echo; FLASH ϭ fast low-angle shot; G RO ϭ readout gradient; NSA ϭ number of signal averages; PROPELLER ϭ periodically rotated overlapping parallel lines with enhanced reconstruction; RF ϭ radio-frequency M R imaging is an ideal diagnostic technique for the evaluation of infants and fetuses 1-7 because of the absence of ionizing radiation, the superior contrast of soft tissues compared with sonography, and the availability of different contrast options (T1-weighted, T2-weighted, and diffusion-weighted imaging, Fig 1) to improve characterization of both anatomy and pathology. However MR imaging remains a relatively slow technique, with scanning times for most applications in the order of seconds to minutes, leaving them susceptible to motion artifacts. The normally mobile fetus and the unsettled neonate present a major difficulty because the presence of motion during a long acquisition will decrease image quality in the form of motion artifacts (Fig 2), hamper accurate image interpretation, and often necessitate a repeat MR imaging to establish a diagnosis. This may have major emotional implications for parents and can stress the tight budgets of health care providers.

Background: Parenteral nutrition is central to the care of very immature infants. Current international recommendations favor higher amino acid intakes and fish oil–containing lipid emulsions.Objective: The aim of this trial was to compare 1) the effects of high [immediate recommended daily intake (Imm-RDI)] and low [incremental introduction of amino acids (Inc-AAs)] parenteral amino acid delivery within 24 h of birth on body composition and 2) the effect of a multicomponent lipid emulsion containing 30% soybean oil, 30% medium-chain triglycerides, 25% olive oil, and 15% fish oil (SMOF) with that of soybean oil (SO)-based lipid emulsion on intrahepatocellular lipid (IHCL) content.Design: We conducted a 2-by-2 factorial, double-blind, multicenter randomized controlled trial.Results: We randomly assigned 168 infants born at <31 wk of gestation. We evaluated outcomes at term in 133 infants. There were no significant differences between Imm-RDI and Inc-AA groups for nonadipose mass [adjusted mean difference: 1.0 g (95% CI: −108, 111 g; P = 0.98)] or between SMOF and SO groups for IHCL [adjusted mean SMOF:SO ratio: 1.1 (95% CI: 0.8, 1.6; P = 0.58]. SMOF does not affect IHCL content. There was a significant interaction (P = 0.05) between the 2 interventions for nonadipose mass. There were no significant interactions between group differences for either primary outcome measure after adjusting for additional confounders. Imm-RDI infants were more likely than Inc-AA infants to have blood urea nitrogen concentrations >7 mmol/L or >10 mmol/L, respectively (75% compared with 49%, P < 0.01; 49% compared with 18%, P < 0.01). Head circumference at term was smaller in the Imm-RDI group [mean difference: −0.8 cm (95% CI: −1.5, −0.1 cm; P = 0.02)]. There were no significant differences in any prespecified secondary outcomes, including adiposity, liver function tests, incidence of conjugated hyperbilirubinemia, weight, length, mortality, and brain volumes.Conclusion: Imm-RDI of parenteral amino acids does not benefit body composition or growth to term and may be harmful. This trial was registered at www.isrctn.com as ISRCTN29665319 and at eudract.ema.europa.eu as EudraCT 2009-016731-34.

together with 95% CIs for the estimates. These data should indicate to clinicians how much confi dence can be placed in a prognosis assigned after neuroimaging. CRANIAL ULTRASOUNDImages were interpreted as normal if there was no haemorrhage in the germinal matrix, ventricles or brain tissue, no evidence of brain tissue destruction and no marked ventricular dilatation. Periand intraventricular haemorrhage (IVH) was classifi ed according to the scale of 1-4 after Papile et al 6 or the broadly similar scale developed by Volpe 7 with cerebellar haemorrhage considered separately. We grouped together images that suggested focal or multifocal tissue destruction due to cystic periventricular leukomalacia (PVL). In the absence of precise measurements in many studies, we made pragmatic decisions on defi ning moderate and severe ventricular dilation. The probabilities of cerebral palsy associated with specifi c imaging fi ndings are given in table 1, together with the 95% CIs for those estimates. Normal scanA series of studies over a 30-year period have shown that a normal ultrasound scan provides considerable confi dence that an infant will have normal neuromotor development. The predictive accuracy is high and confi dence limits narrow: in one typical study the PPV was 99% (95% CI 98% to 99%) 8 ; combining suitable studies, the pooled probability for normal outcome was 94% (95% CI 92% to 96%), [8][9][10][11][12] although heterogeneity between studies was high (I 2 88%). Cognitive impairment is excluded slightly less effectively: in a typical large study, a normal ultrasound scan predicted normal cognitive function with a PPV of 77% (95% CI 74% to 80%), 13 and the pooled probability of a normal cognitive outcome with a normal ultrasound scan is 82% (95% CI 79% to 85%). 11 13 Grade 1 or 2 IVHIn one major study, images with only grade 1 or 2 IVH showed a low risk of abnormal neuromotor development with narrow confi dence limits: PPV 6% (95% CI 4% to 9%). 9 Combining studies together produced broadly similar fi ndings but with wider confi dence limits, the pooled probability of abnormal neuromotor development being 9% (95% CI 4% to 22%). 9 14