Elsevier

Early Human Development

Volume 85, Issue 12, December 2009, Pages 779-783
Early Human Development

A patient care system for early 3.0 Tesla magnetic resonance imaging of very low birth weight infants

https://doi.org/10.1016/j.earlhumdev.2009.10.007Get rights and content

Abstract

Background

Very low birth weight (VLBW) infants (weight < 1500 g) are increasingly cared for without prolonged periods of positive pressure ventilation (PPV).

Aims

To develop a system for 3.0 T magnetic resonance (MR) image acquisition from VLBW infants who are not receiving PPV, and to test the clinical stability of a consecutive cohort of such infants.

Design

Seventy VLBW infants whose median weight at image acquisition was 940 g (590–1490) underwent brain MR imaging with the developed care system as participants in research. Twenty infants (29%) received nasal continuous positive airway pressure (nCPAP), 28 (40%) received supplemental oxygen by nasal cannulae, and 22 (31%) breathed spontaneously in air during the MR examination.

Results

There were no significant adverse events. Seventy-six percent had none or transient self-correcting oxygen desaturations. Desaturations that required interruption of the scan for assessment were less common among infants receiving nCPAP (2/20) or breathing spontaneously in air (2/22), compared with those receiving nasal cannulae oxygen (13/28), p = 0.003. Sixty-four (91%) infants had an axillary temperature ≥ 36 °C at completion of the scan (lowest 35.7 °C), There was no relationship between weight (p = 0.167) or use of nCPAP (p = 0.453) and axillary temperature < 36 °C. No infant became hyperthermic.

Conclusion

VLBW infants who do not require ventilation by endotracheal tube can be imaged successfully and safely at 3.0 T, including those receiving nCPAP from a customised system.

Introduction

Preterm infants are at high risk of neurodevelopmental impairment in childhood [1], [2] and magnetic resonance (MR) imaging has proven to be a powerful tool for assessing the disturbances to brain structure and function that could underlie impairment in this population (for review see [3]). Most large MR series report on preterm infants at term equivalent age [4], [5], [6], [7], but a number of smaller studies have established the scientific and clinical value of analyzing images acquired soon after birth, and this approach is likely to be useful for understanding early growth patterns and the pathways to abnormal development that operate in the perinatal period [8], [9], [10], [11], [12], [13], [14], [15], [16], [17].

We and others have described systems for safe imaging of very low birth weight (VLBW) infants receiving mechanical ventilation [9], [18], [19]. However, in common with many other institutions, the Neonatal Intensive Care Unit (NICU) at Queen Charlotte's and Chelsea Hospital (QCCH) now practise early extubation to ventilation by nasal continuous positive airway pressure (nCPAP) for the majority of preterm infants because of the apparent benefits to respiratory function with avoidance of prolonged mechanical ventilation [20], [21]. This development in care presents technical and clinical challenges for examining VLBW infants in the MR environment in terms of equipment and maintenance of physiological stability.

The aims of this paper are: first, to describe a system for MR examination at 3.0 T of VLBW infants who do not require mechanical ventilation; and second, to test the clinical stability of a consecutive cohort of VLBW infants who have undergone early MR imaging as participants in research.

Section snippets

Study group

Seventy-two infants were recruited to a research project that involves early brain MR image acquisition to study the effect of preterm birth on brain growth and neurodevelopmental outcome. The project has ethical approval from the Hammersmith and Queen Charlotte's and Chelsea Research Ethics Committee and written informed parental consent was obtained in each case. Infants were recruited over a 20 month period (2007–2008), and all weighed less than 1500 g at the time of image acquisition. Infants

Results

Seventy VLBW infants underwent successful image acquisition. The median scan time was 55 min (range 35–85). The median PMA at birth was 27.29 weeks (24.57–36.29), and the median birth weight was 965 g (580–1575). The infants were imaged on median day 14 (range 1–45), at median post menstrual age of 30.0 weeks (25.29–37.14), and median weight of 940 g (590–1490).

Twenty-two (31%) were breathing spontaneously in air, 28 (40%) were receiving nasal cannulae oxygen and 20 (29%) were receiving nCPAP during

Discussion

We have tested a customised system for acquiring 3.0 T MR image data from VLBW infants before term equivalent age, including those receiving nCPAP, and shown it to be safe and effective. The physiological parameters of heart rate and oxygen saturation were stable during the examination, and the thermal care measures described were successful in maintaining an axillary temperature ≥ 36 °C for the duration of the scan for 91% of infants. The use of nCPAP was associated with improved

Conflict of interest statement

None declared.

Acknowledgements

We thank the parents who chose to take part in the study and the staff on the Neonatal Intensive Care Unit at Queen Charlotte's and Chelsea Hospital who helped to care for patients during the scanning procedure. We thank Mr. Neil Prime and Mr. Ben Coombe (both Fisher and Paykel Healthcare Corporation Limited) who assisted in the designing of the customised nCPAP system. We are grateful for support from the NIHR Biomedical Research Centre funding scheme, the Garfield Weston foundation, the

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