Swaddling Technique for Alternative to Sedative Administration during Brain Magnetic Resonance Imaging in Very Low Birth Weight Infants

Background: Magnetic resonance imaging (MRI) of neonates is an essential modality to diagnose brain injury in premature infants and evaluate growth development. Newborns are often sedated during MRI because this modality is required minimal motion to acquire qualified process. However, sedation may cause adverse effects and induces potential neurotoxicity.

Objective: This study investigated the neonate cases that were performed MRI to describe effectiveness of swaddling by comparing with administration of sedative agents.

Methods: This was a retrospective study of premature infants who received swaddling or sedatives (chloral hydrates or benzodiazepines) for brain MRI in the neonatal intensive care unit (NICU). Among the enrolled infants (N=79), 40.5% (N=32) were included in the swaddling group and 59.5% (N=47) were in the sedative group.

Results: There were no differences in gestational age (GA) at birth [29⁺³ ± 4⁺¹ vs. 29⁺⁶ ± 5⁺¹, P=0.439] and corrected GA at conducting MRI [37⁺⁴ ± 2⁺³ vs. 37⁺⁶ ± 3⁺¹, P=0.649]. In univariate analysis, mean body weight at birth [1188.9 (± 246.4) vs. 1167.4 (± 259.9), P=0.714] and at conducting MRI [2439.7 (± 484.4) vs. 2250.3(± 548.7), P=0.119] were similar between groups. There was no significant difference in failure rate of performing MRI [12.5%(N = 4) vs. 4.3% (N = 2), P = 0.174]. Average of MRI scanning time was longer in swaddling group than sedation group [76.5 (± 20.3) vs. 61.5 (± 13.6), P=0.001]. Mean time from end of scan to restart feeding was shorter in swaddling group than sedation group [57.9 (± 48.2) vs. 74.0 (± 70.2), P=0.233].

Conclusion: The failure rate of swaddling technique was comparable to sedative administrations during MRI. Furthermore, swaddling may reduces not only adverse events but also neurotoxic effects compare to administration of sedative agents. Therefore, it can be considered prior to an MRI scan, avoiding sedation or anesthesia.