Can we reduce anesthesia exposure? Neonatal brain MRI: Swaddling vs. sedation, a national survey

Study objective Neonatal magnetic resonance imaging (MRI) is a diagnostic modality that requires minimal motion to acquire quality images. Sedation or even general anesthesia may be necessary to achieve acceptable scans. There is a growing body of literature, especially in animal studies, that links neurotoxicity with anesthetic exposure to the developing brain. There is no study outlining strategies used by neonatal intensive care units (NICU) to achieve quality MRI images with limited exposure to medications identified as possibly harmful to the developing brain. Design A 15-question survey was sent to all NICU programs in the United States (US) with fellowship programs. Setting MRI suite. Patients Neonates. Interventions None. Measurements The programs were queried regarding their preferred method for obtaining MRIs of the brain and how successful they were in obtaining quality images. Main results Of the 96 programs surveyed, 58 responded (response rate of 60%). To obtain brain MRIs, 64%(n = 37) used feed and swaddle; 32% (n = 19) use sedation; and 3% (n = 2) used general anesthesia (GA). Success rate of obtaining quality MRI images varied by technique. In the feed and swaddle group, 81% reported that a failure to obtain useful images occurred < 25%; 11% reported that it occurred 25–75%; and 5% reported that it occurred > 75%. In the sedation and GA group, 100% reported failure to obtain useful images occurred rarely. Conclusions The majority of NICUs in the US that responded to the survey utilized feed and swaddle as their primary technique for obtaining MRIs of the brain and reported a high success rate. Given the growing concern over the possible neurotoxic effects of anesthetic drugs on the developing brain, more centers should consider this technique as a first line method to obtain brain MRIs, with sedation and GA reserved for failed feed and swaddle attempts and special circumstances.