Neonatal brain MRI to prognosticate neurodevelopmental outcomes in fetal growth restricted infants: a systematic review

Aim: The purpose of this study was to identify magnetic resonance imaging (MRI) brain markers at birth that prognosticate neurodevelopmental outcomes at ≥12 months of age in fetal growth restricted (FGR) infants. Methods: A systematic literature search was undertaken in PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus in March 2025. Articles were assessed by two reviewers. The inclusion criteria included papers relating to infants with birth weight 12 months of age across all studied infants. However, only one of the three studies correlated early MRI results with neurodevelopmental outcomes specifically in FGR infants and thus a meta-analysis could not be performed. The single study reports a positive correlation between MRI total parenchyma area and cognitive scores in FGR infants. Conclusion: The current literature highlights the developmental risk in FGR vs. AGA infants. FGR neonates have significantly different MRI results compared to AGA neonates and MRI findings in the neonate are associated with adverse neurodevelopmental outcomes. However, current evidence is insufficient to firmly establish MRI prognostic capabilities specifically for FGR infants. Sub-group analysis of the FGR cohort in the reported studies and the use of more advanced MRI techniques would likely elucidate this. Further research is required to ascertain robust clinical MRI markers of early adverse brain development in the FGR newborn. Systematic Review Registration: identifier CRD42023400436.