Summary

Preparing neonates for an MRI scan presents unique challenges not found in other patients. Proper planning and attention to detail can often make the difference between success and failure.

Discussion

Neonatal patient presents many challenges in MRI. They are unable to cooperate or participate in their care. They cannot follow instructions or communicate and therefore, movement is often a foregone conclusion. Fortunately, there are techniques available that can help ensure neonatal patients successfully undergo MRI. First and foremost, it is essential to ensure motion control. The most common technique used for this purpose is the feed and swaddle. Timing the MRI exam to fall approximately 20-30 minutes after a feeding, combined with a tight swaddle, can often ensure the patient remains asleep for the MRI exam. NICU nurses have a long perfected the tight swaddle (Figure 1) and should be enlisted for this purpose after being properly screened and prepped to enter Zone IV. It bears mentioning that neonatal exams should be performed as quickly as possible with the critical sequences performed first in case the child wakes up. Children who remain agitated can often be calmed by controlled chest percussions mimicking a maternal heartbeat. The best technique for this is to place one hand on the child’s chest and use two fingers to thump the back of the hand gently. Other helpful techniques include turning off the bore light and the circulating fan. For most patients, turning off the circulation fan is contra indicated due to patient warming. But with neonates, this is really not an issue. It’s also beneficial to reduce extraneous noise such as overhead pages, background music, and loud conversations. Pacifiers without or with sugar water sometimes can be beneficial but it varies from child to child. As a last resort medical sedation or even general anesthesia are available but not often desirable in the neonatal population. In addition to motion control, is it imperative to protect the neonate’s hearing. Several passive noise attenuators are available for the adult population which are not sized specifically for the neonate. Therefore, adaptations must be made. Traditionally, earplugs designed for adults and even children Figure 2) are too big to fit into a neonatal ear canal. Cutting the earplugs in half lengthwise is a common modification but the effect on the overall noise reduction rating (NRR) is unknown. Pedi-muffs, that are designed to fit over the ear (Figure 3), have a very low NRR and are not recommended to be used alone. Conversely, they are only intended to be used on preterm neonates up to 1 month of age. They are not designed for full-term neonates over 2 months of age. There’s anecdotal evidence that some sites use materials such as dental putty and moldable clay to obstruct the ear canal, but the attenuation value of these materials has not been evaluated and their use is not recommended. New methods for hearing protection include active noise cancelling headphones (Figure 4), but these have not been designed for neonates to date. An alternative product, originally designed for use on neonates in the Neonatal Intensive Care Unit (NICU) and medical transport (Figure 5), is currently being evaluated inside the MRI. The device consists of a neoprene band which properly positions sound attenuating cups over the neonate’s ear forming a tight seal. Several sizes are available to accommodate neonates with a full range of head circumferences from 23 – 39 cm.

Conclusion

With a little patience and, creativity and some upfront planning, it’s entirely possible to scan almost all neonatal patient without the need for sedation or anesthesia.

Acknowledgements

No acknowledgement found.

References

No reference found.