Deep sedation in lateral position for preterm infants during cerebral magnetic resonance imaging: a pilot study

Abstract

Introduction Respiratory adverse events are common during the sedation of preterm babies, often needing active airway support. During magnetic resonance imaging, this occurrence could extend the acquisition time, with a negative impact on the thermic and metabolic homeostasis. The aim of the study is to verify if lying in a lateral position instead of supine could improve the safe quality of sedation, without worsening the quality of imaging. Methods This study was performed as a single-center, prospective study at a university-affiliated tertiary care center. A consultant provided deep sedation with sevoflurane 3–4% delivered by an external mask, in the lateral decubitus position. All patients were evaluated for the incidence of apnea and desaturation, quality of imaging obtained, the timing of imaging acquisition, and thermic and metabolic homeostasis. Results We enrolled 23 consecutive preterm babies born < 37 weeks gestational age, candidates for sedation for elective brain magnetic resonance imaging. All patients completed the radiological procedure in 30 min (SD ± 6.39 min) without complications requiring exam interruption. Only one patient (4%) experienced a transient desaturation, while 2 neonates (9%) showed apnea lasting > 20 s. On average, there was a 1 °C decrease in body temperature and full enteral feeding was resumed within 1.5 h. Neuroradiologists rated the quality of the images obtained as high. Conclusions Lateral lying seems to be a viable option for sedated preterm babies during magnetic resonance imaging with a low risk of intervention for apnea and a reduced impact on thermic and metabolic homeostasis. Quality of imaging would be preserved maintaining correct scheduling of standard care. Trial registration The study was registered at www.ClinicalTrials.gov before enrollment (NCT05776238 on December, 21th 2023).