Hwang Misun, Barton Katherine, Kim Jane S, Machnitz Andrea J, Holm Tara, Maianski Irit, Setty Bindu N, Birkemeier Krista L, Radhakrishnan Rupa, Sreedher Gayathri, Victoria Teresa, Nikam Rahul, Sintim-Damoa Akosua, Ho Mai-Lan
Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
Department of Radiology, Oregon Health and Science University, Portland, OR, USA.
Pediatr Radiol. 2022 Dec;52(13):2630-2635. doi: 10.1007/s00247-022-05423-6. Epub 2022 Jun 29.
There is little data regarding the use of sedation and anesthesia for neonatal imaging, with practice patterns varying widely across institutions.
To understand the current utilization of sedation and anesthesia for neonatal imaging, and review the current literature and recommendations.
One thousand, two hundred twenty-six questionnaire invitations were emailed to North American physician members of the Society for Pediatric Radiology using the Survey Monkey platform. Descriptive statistical analysis of the responses was performed.
The final results represented 59 institutions from 26 U.S. states, the District of Columbia and three Canadian provinces. Discrepant responses from institutions with multiple respondents (13 out of 59 institutions) were prevalent in multiple categories. Of the 80 total respondents, slightly more than half (56%) were associated with children's hospitals and 44% with the pediatric division of an adult radiology department. Most radiologists (70%) were cognizant of the neonatal sedation policies in their departments. A majority (89%) acknowledged awareness of neurotoxicity concerns in the literature and agreed with the validity of these concerns. In neonates undergoing magnetic resonance imaging (MRI), 46% of respondents reported attempting feed and bundle in all patients and an additional 46% attempt on a case-by-case basis, with most (35%) using a single swaddling attempt before sedation. Sedation was most often used for neonatal interventional procedures (93%) followed by MR (85%), nuclear medicine (48%) and computed tomography (31%). More than half of respondents (63%) reported an average success rate of greater than 50% when using neonatal sedation for MR.
Current practice patterns, policies and understanding of the use of sedation and anesthesia for neonatal imaging vary widely across institutions in North America, and even among radiologists from the same institution. Our survey highlights the need for improved awareness, education, and standardization at both the institutional level and the societal level. Awareness of the potential for anesthetic neurotoxicity and success of non-pharmacologic approaches to neonatal imaging is crucial, along with education of health care personnel, systematic approaches to quality control and improvement, and integration of evidence-based protocols into clinical practice.
关于新生儿影像学检查中镇静和麻醉的使用数据很少，各机构的实践模式差异很大。
了解新生儿影像学检查中镇静和麻醉的当前使用情况，并回顾当前的文献和建议。
使用Survey Monkey平台向北美儿科放射学会的医师会员发送了1226份问卷邀请。对回复进行描述性统计分析。
最终结果代表了来自美国26个州、哥伦比亚特区和加拿大三个省的59家机构。在多个类别中，有多个回复者的机构（59家机构中的13家）的不一致回复很普遍。在总共80名回复者中，略多于一半（56%）与儿童医院有关，44%与成人放射科的儿科部门有关。大多数放射科医生（70%）了解其所在部门的新生儿镇静政策。大多数人（89%）承认了解文献中关于神经毒性的担忧，并同意这些担忧的合理性。在接受磁共振成像（MRI）检查的新生儿中，46%的回复者报告称在所有患者中尝试喂奶和包裹，另外46%根据具体情况尝试，大多数（35%）在镇静前仅进行一次包裹尝试。镇静最常用于新生儿介入手术（93%），其次是MRI（85%）、核医学（48%）和计算机断层扫描（31%）。超过一半的回复者（63%）报告称，在对新生儿进行MRI镇静时，平均成功率超过50%。
北美各机构在新生儿影像学检查中镇静和麻醉的当前实践模式、政策以及理解差异很大，甚至同一机构的放射科医生之间也存在差异。我们的调查强调了在机构层面和社会层面提高认识、教育和标准化的必要性。认识到麻醉性神经毒性的可能性以及非药物方法在新生儿影像学检查中的成功至关重要，同时还需要对医护人员进行教育、采取系统的质量控制和改进方法，并将循证方案纳入临床实践。
