Presented at ASA, October 24, 2015
Scott Lipson, M.D., Benjamin Heller, M.D.
Icahn School of Medicine at Mount Sinai, New York, New York, United States
There is increasing literature raising a possible link between anesthetic exposure to the developing brain and neuro-toxicity. There is concern for these possible effects from almost all medications used for sedation and general anesthesia(GA). Concern has reached the point where the FDA, SmartTots and the American Academy of Pediatrics have recommended that elective procedures with anesthesia be delayed until three years of age. Neonatal MRI is an increasingly used modality for diagnosis without radiation exposure. There are multiple techniques used to obtain a motionless state for these MRIs. Reports of techniques vary widely from sedation or GA to those using only a feed and swaddle technique(FS) avoiding all pharmacology. Most neonatal MRIs are not elective procedures, however it appears that exposure to anesthetic medications may be elective and based on individual practitioner or center preference.
To quantify the techniques used by NICUs and hospitals across the U.S. to keep neonates motionless for brain MRIs; to determine the success rate of MRI images with these approaches.
A 15 question survey was sent to all the NICU programs in the U.S. with fellowship programs. 58 NICUs responded out of 96 surveyed, a response rate of 60%. Institutions were queried for demographics and if they performed MRIs with sedation, GA, or by FS. Based on the approach used to obtain MRIs, 5 sub-section questions were asked to determine what medications or swaddling techniques are used and to approximate the success rate of these techniques.
To obtain brain MRIs, 64%(n=37) of NICUs use FS; 32% (n=19) use sedation; 3% (n=2) use GA. Success rate of obtaining useful MRI images varied by technique. In the FS group, 81% reported that a failure to obtain useful images occurred Rarely(<25%); 11% reported that it occurred Sometimes (25-75%); and 5% of reported that it occurred Frequently (>75%). 100% of the sedation and GA groups reported failure to obtain useful images occurred Rarely.
There is no standard technique used by hospitals in the U.S. to obtain a motionless state for brain MRIs. We found a high reported rate of success with FS. Given the growing concern over the possible neuro-toxic effects of anesthetic drugs on the developing brain, it seems more centers should consider this technique. We recommend that FS should be the first line method used to obtain brain MRIs, with sedation and GA reserved for special circumstances or failed FS attempts.