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Deep sedation in lateral position for preterm infants during cerebral magnetic resonance imaging: a pilot study
Fabio Sbaraglia1, Simona Gaudino2, Eloisa Tiberi3
1Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. fabio.sbaraglia@policlinicogemelli.it.
Insights
Lateral positioning during sedation for MRI in preterm infants is safe and effective. This method minimizes respiratory events and impacts on homeostasis, ensuring high-quality imaging without complications.
Area of Science:
- Neonatal care
- Pediatric radiology
- Sedation management
Background:
- Respiratory adverse events are common in sedated preterm infants, potentially prolonging MRI scans and affecting homeostasis.
- Active airway support is often required, complicating procedures for vulnerable neonates.
Purpose of the Study:
- To evaluate the safety and efficacy of the lateral decubitus position for sedation in preterm infants undergoing MRI.
- To determine if this position improves sedation quality without compromising imaging results or homeostasis.
Main Methods:
- A prospective, single-center study involving 23 preterm infants (<37 weeks gestational age) undergoing elective brain MRI.
- Deep sedation with sevoflurane was administered in the lateral decubitus position.
- Infants were monitored for apnea, desaturation, imaging quality, procedure timing, and thermic/metabolic homeostasis.
Main Results:
- All 23 infants completed the MRI within 30 minutes without interruption.
- Only one infant (4%) experienced transient desaturation; two (9%) had apnea >20 seconds.
- Body temperature decreased by an average of 1°C, and feeding resumed within 1.5 hours. Image quality was rated as high.
Conclusions:
- Lateral positioning is a safe and viable option for sedated preterm infants during MRI.
- This position is associated with a low risk of respiratory complications and minimal impact on homeostasis.
- High-quality imaging can be achieved, supporting standard care scheduling.
Introduction:
Respiratory adverse events are common during the sedation of preterm babies, often needing active airway support. During magnetic resonance imaging, this occurrence could extend the acquisition time, with a negative impact on the thermic and metabolic homeostasis. The aim of the study is to verify if lying in a lateral position instead of supine could improve the safe quality of sedation, without worsening the quality of imaging.
Methods:
This study was performed as a single-center, prospective study at a university-affiliated tertiary care center. A consultant provided deep sedation with sevoflurane 3-4% delivered by an external mask, in the lateral decubitus position. All patients were evaluated for the incidence of apnea and desaturation, quality of imaging obtained, the timing of imaging acquisition, and thermic and metabolic homeostasis.
Results:
We enrolled 23 consecutive preterm babies born < 37 weeks gestational age, candidates for sedation for elective brain magnetic resonance imaging. All patients completed the radiological procedure in 30 min (SD ± 6.39 min) without complications requiring exam interruption. Only one patient (4%) experienced a transient desaturation, while 2 neonates (9%) showed apnea lasting > 20 s. On average, there was a 1 °C decrease in body temperature and full enteral feeding was resumed within 1.5 h. Neuroradiologists rated the quality of the images obtained as high.
Conclusions:
Lateral lying seems to be a viable option for sedated preterm babies during magnetic resonance imaging with a low risk of intervention for apnea and a reduced impact on thermic and metabolic homeostasis. Quality of imaging would be preserved maintaining correct scheduling of standard care.
Trial Registration:
The study was registered at www.
Clinicaltrials:
gov before enrollment (NCT05776238 on December, 21th 2023).
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