Daoud Ghalib, Karayil Mohammad Ali Sanoj, Chakkarapani Aravanan Anbu, Durrani Naveed Ur Rehman
Department of Pediatrics, Neonatal Division, Sidra Medicine, Doha, Qatar.
Department of Pediatrics, Weill Cornell Medicine, Al Rayyan, Qatar.
Biomed Hub. 2024 May 22;9(1):73-82. doi: 10.1159/000538762. eCollection 2024 Jan-Dec.
Magnetic resonance imaging (MRI) is a common procedure in tertiary care neonatal intensive care units (NICUs). MRIs aid in detailing structural anatomy and are increasingly utilized for prognostication. Keeping babies calm and motion-free in the MRI suite is challenging, and various approaches have been adopted to obtain the best image quality. We share our experience of intervention bundle for procedural sedation with the novel use of buccal midazolam in our NICU for babies undergoing MRI.
This single-center quality improvement project comprised two epochs. Epoch 1 from April 2018 to December 2020 provided baseline data regarding sedation use and helped identify causes for suboptimal images and the adverse event rate. Following the implementation of an interventional bundle comprising specific midazolam dose recommendations tailored to background risk factors and streamlining the procedural sedation process, similar comparative data were collected in epoch 2 (May 2021 to December 2022) after a washout period.
Of 424 patients, 238 and 108 had MRI done under either procedural sedation protocol or feed and wrap technique in epoch 1 and 2, respectively. After excluding babies whose MRIs were performed under sedative infusions, 30 (13%) babies had adverse events in epoch 1, while only 8 (7%) events occurred in epoch 2. There was also a 37% improvement in the documentation of procedural sedation between the two epochs.
Procedural sedation with buccal midazolam under neonatologist supervision is safe, efficient, and effective in babies undergoing MRI in this single-center study. More extensive studies may be warranted to assess the suitability of this sedation modality for broader use.
磁共振成像（MRI）是三级医疗新生儿重症监护病房（NICU）中的常见检查项目。MRI有助于详细显示结构解剖，并且越来越多地用于预后评估。在MRI检查室让婴儿保持安静且无运动是一项挑战，人们已采用各种方法来获得最佳图像质量。我们分享在NICU中对接受MRI检查的婴儿采用新型颊部咪达唑仑进行程序性镇静的干预方案的经验。
这项单中心质量改进项目包括两个阶段。2018年4月至2020年12月的第1阶段提供了关于镇静使用的基线数据，并有助于确定图像欠佳的原因和不良事件发生率。在实施了一项干预方案，该方案包括根据背景风险因素制定的特定咪达唑仑剂量建议并简化程序性镇静流程后，在洗脱期过后的第2阶段（2021年5月至2022年12月）收集了类似的比较数据。
在424例患者中，分别有238例和108例在第1阶段和第2阶段接受了程序性镇静方案或喂食包裹技术下的MRI检查。在排除接受镇静剂输注进行MRI检查的婴儿后，第1阶段有30例（13%）婴儿发生不良事件，而第2阶段仅发生8例（7%）事件。两个阶段之间程序性镇静记录也有37%的改善。
在这项单中心研究中，在新生儿科医生监督下使用颊部咪达唑仑进行程序性镇静对接受MRI检查的婴儿是安全、高效且有效的。可能需要进行更广泛的研究来评估这种镇静方式更广泛应用的适用性。
