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‘Feed and wrap’ or sedate and immobilise for neonatal brain MRI?
  1. Therese Ibrahim1,
  2. Karen Few1,
  3. Richard Greenwood2,
  4. Cheryl Smith2,
  5. Paul Malcolm2,
  6. Glyn Johnson3,
  7. Pete Lally4,
  8. Sudhin Thayyil4,
  9. Paul Clarke1
  1. 1 Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
  2. 2 Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
  3. 3 Norwich Medical School, University of East Anglia, Norwich, UK
  4. 4 Department of Paediatrics, Centre for Perinatal Neurosciences, Imperial College, London, UK
  1. Correspondence to Dr Paul Clarke, Neonatal Intensive Care Unit, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich NR4 7UY, UK; paul.clarke{at}

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Successful neonatal brain MRI relies on having a settled infant within the scanner to permit acquisition of the necessary sequences and good-quality images. Unsettledness may lead to incomplete or unsuccessful scans, and costly rescheduled scans with concomitant parental anxiety and inconvenience. Significant motion artefact may confound or preclude interpretation, leading to diagnostic errors.1 Use of premedication to assist neonatal MRI is controversial: routine sedation can be used safely and effectively in neonates2 though some report successful whole-body MRI without sedation.3 It is unclear how widely routine sedation premedication is practised.

In October 2013, our centre (Norwich) electively introduced routine use of chloral hydrate sedation along with a body splint-immobilising device for neonatal MRI. We aimed to: (a) review our experience with MRI quality and success in epochs before and after introducing sedation and vacuum immobilisation, (b) determine current UK practices regarding use of sedation for neonatal brain MRI.

We …

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  • Contributors PC conceived the idea for this study and devised the grading system. RG, PM, GJ, PL and ST facilitated 3 Tesla MRI set-up and data acquisition. KF and CS assisted with clinical monitoring and data acquisition. TI did the telephone survey. TI and PC graded MRI reports and analysed the data. PC and TI wrote the first manuscript draft. All authors contributed to manuscript revision and approve the final version. PC is the guarantor.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The review of clinical MRI radiology reports was a service evaluation/audit and neither this nor the telephone survey of current practices required formal REC review under current UK NRES guidance. The MARBLE study has prior ethics approval (REC Ref. 11/H0717/6).

  • Provenance and peer review Not commissioned; internally peer reviewed.