"Feed-and-wrap" technique versus deep sedation for neonatal magnetic resonance imaging: a retrospective comparative study

André Lollert; Kim Sophie Frey; Christian Hoffmann; Markus Herbst; Jochem König; Isabella Schmeh; Frank Dette; Gundula Staatz

doi:10.1007/s00330-024-10777-6

"Feed-and-wrap" technique versus deep sedation for neonatal magnetic resonance imaging: a retrospective comparative study

Eur Radiol. 2024 May 7. doi: 10.1007/s00330-024-10777-6. Online ahead of print.

Authors

André Lollert¹, Kim Sophie Frey², Christian Hoffmann², Markus Herbst³, Jochem König³, Isabella Schmeh⁴, Frank Dette⁵, Gundula Staatz²

Affiliations

¹ Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Medical Center of the Johannes Gutenberg-University, Mainz, Germany. andre.lollert@unimedizin-mainz.de.
² Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
³ Institute of Medical Biostatistics, Epidemiology and Informatics, Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
⁴ Department of Pediatrics and Adolescent Medicine, Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
⁵ Department of Anaesthesiology, Medical Center of the Johannes Gutenberg-University, Mainz, Germany.

PMID: 38713278
DOI: 10.1007/s00330-024-10777-6

Abstract

Objectives: Neonatal MRI is usually performed under deep sedation, which is challenging-especially in low-weight premature patients. In addition, long-term side effects, such as neurotoxicity, are of concern. An alternative to sedation is to induce natural sleep by feeding and immobilising the child, the "feed-and-wrap" technique (FWT). The objective of this study was to evaluate differences in image quality between neonates examined under sedation and by using the FWT during the first four months of life.

Materials and methods: We retrospectively assessed image quality (based on a 4-point semiquantitative scale) of all MRI examinations in neonates performed at our institution between July 2009 and August 2022. Differences in image quality between examinations under sedation versus FWT were evaluated.

Results: We included 432 consecutive patients, 243 (56%) using sedation and 189 (44%) using the FWT. Corrected age and body weight (mean ± SD: 3.7 ± 1.1 versus 4.5 ± 1.3 kg, p < 0.001) were significantly lower in the FWT group. The overall success rate in the FWT group was 95%. Image quality was slightly lower when using the FWT (mean ± SD: 3.7 ± 0.43 versus 3.96 ± 0.11, p < 0.001). Multivariate analysis showed a higher risk of acquiring sequences with diagnostic limitations in the FWT group (p < 0.001), increasing with corrected age (p = 0.048).

Conclusion: The FWT is a highly successful method to perform MRI scans in term and preterm neonates. Overall image quality is only slightly lower than under sedation. Especially in immature low-weight preterm patients, the FWT is a reliable option to perform MRI studies without exposing the child to risks associated with sedation.

Clinical relevance statement: The "feed-and-wrap" technique enables high-quality MRI examinations in neonates, including low-weight premature patients. Deep sedation for diagnostic MRI procedures in this age group, which has the risk of short- and long-term complications, can often be avoided.

Key points: Deeply sedating neonates for MR examinations comes with risks. Image quality is only slightly lower when using the "feed-and-wrap" technique. The "feed-and-wrap" technique is feasible even in low-weight premature infants.

Keywords: Infant; Magnetic resonance imaging; Neonate; Sedation; “Feed-and-wrap”.