Impact of a Sedation Reduction Protocol in Infants Undergoing MRI Scanning

Brain magnetic resonance imaging (MRI) is an important diagnostic tool for infants with possible brain abnormalities. While sedation may be necessary for high quality images, it carries risks of complications. The sedation rate for MRI procedure varies widely, ranging from 0% to 100%, influenced by infant characteristics and institutional practices, with an increasing focus on non-sedated or minimally sedated approaches to reduce risks.

We studied sedation utilization in infants undergoing MRI scanning before and after implementing an MRI bundle.

This cohort study utilized a pre- post-intervention design. An MRI bundle, including a process map, a safety checklist and a questionnaire collecting detailed information on sedation, were developed for our off-unit MRI suite. Pre-intervention group included infants scanned March 2018 to February 2019, and Post-intervention group March 2019 to February 2022. We hypothesized that sedation rates would significantly decrease following the intervention.

In the study, 229 infants in the Pre-Intervention group and 764 infants in the Post-Intervention group underwent MRI scanning. Sedation use decreased by 62%, from 29% pre-intervention to 18% post-intervention ( P = 0.0003). Post-intervention infants were 47.6% less likely to be sedated, adjusting for gestation-corrected age (OR 0.524 [0.369, 0.745]; P < 0.01). Each 1-week increase in gestation-corrected age was associated with a 7.1% increase in the odds of sedation, controlling for the intervention time-period (OR 1.071 [1.022, 1.122]; P = 0.004). The questionnaire was completed 72% of the time in the post-intervention group.

A standardized approach and protocol development can significantly reduce sedation for neonatal MRI. This study offers guidance for future research and integrated care interventions across medical teams.