MRI Scans in the Neonatal Period - Care of Neonatal Unit Patients Receiving Inpatient

Publication: 09/07/2014  --
Last review: 09/03/2020  
Next review: 09/03/2023  
Standard Operating Procedure
CURRENT 
ID: 3893 
Approved By: Neonatal clinical governance group MRI anaesthetists 
Copyright© Leeds Teaching Hospitals NHS Trust 2020  

 

This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Care of Neonatal Unit Patients Receiving Inpatient MRI Scans in the Neonatal Period

Background and indications for standard operating procedure/protocol

A number of neonatal patients require in-patient MRI scans after birth. Indications include

  • Acquired brain injury
  • Congenital brain malformation
  • Investigation of seizures or abnormal neurological signs
  • Clarification of pathology seen on Cranial USS if appropriate

Historically babies were scanned either under general anesthetics (GA) or on a research list, under chloral hydrate sedation accompanied by a research fellow. More recently with the cessation of the research list, babies have been having MRIs without sedation, usually after a feed- so called “feed and wrap” scans. This has led to an increase in the amount of movement artifact, and several babies requiring re-scan or less diagnostic accuracy. We therefore plan to re-instate the use of monitored and supervised oral sedation for neonatal inpatient MRI scans.

This operating procedure only applies to neonatal patients from the NNU at Leeds General Infirmary. Neonates on other paediatric wards or St James’s NNU or who are outpatients must not follow this protocol.

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Procedure method (step by step)

  • Baby receiving any respiratory support or oxygen- will require general aneasthesia or supervision by a paediatric anaesthetists. Discuss with MRI unit and on-call acute anaesthetist. Note: all metal containing devices /clothes  must still be removed before leaving the unit (see below)
  • Stable baby, who has not required respiratory support or oxygen for more than 24 hours: can be considered for oral sedation provided the following criteria:
    • Parents have provided written consent, including for sedation.
    • A middle grade neonatologist or ANNP with advanced airway skills and a neonatal nurse is available to accompany the baby throughout the scan.
    • The consultant has assessed that the baby is safe to sedate
    • A timed slot is available within the MRI unit
    • An MRI compatible saturation monitor is available within MRI unit.
    • Neonatal staff are aware of MRI specific safety issues

Preparation for scan

  1. Arrange MRI appointment with MRI unit (Clarendon wing) after discussion with a Neuro or Paediatric Radiologist for approval.  Sedation can only be used for any of the following scans, which have been confirmed by MRI staff as lasting 45 minutes or less:
    • Head
    • Spine
    • Face/Neck
    • Pelvis/Hips
    • Upper Limb
    • Lower Limb

      Please ring the Radiographers on 23378 to discuss cases for MRI in the first instance.

  2. Confirm that baby meets criteria for sedation (above)

  3. Obtain written consent from parents for MRI under oral sedation.

  4. Prescribe Chloral hydrate 50mg/kg PO/NG as a single dose to be given 30-40 minutes before the MRI scan time.

  5. Complete the MRI safety checklist for baby : Download the MRI safety form: http://lthweb.leedsth.nhs.uk/sites/radiology-intranet/departments/magnetic-resonance-imaging-mri/MRIScreenForm.pdf

    This must be completed by or in conjunction with the parent. Ward medical staff should only complete in an emergency or if the child is in social care.  Fax to 24489 as soon as possible to prevent delays. For babies who have never left the hospital or parents are not available please use the following form: http://lthweb.leedsth.nhs.uk/sites/radiology-intranet/departments/magnetic-resonance-imaging-mri/confirmation-of-interventions-during-inpatient-admission-for-mri-safety

  6. The patient must be checked for contraindications to MRI.  Patients cannot be scanned with pacemakers or pacing wires in situ and any other medical devices will need to be checked by a Radiographer before you leave the ward with the patient.

  7. Patients who have a protocol for contrast should have functioning IV access

  8. To prepare the patient for transfer, please do the following:
    1. Remove any clothes with metal stud fastenings (including baby vests etc)
    2. If ventilated (and having GA scan with anaesthetist) change NeoFit ET holder to Elastoplast before baby leaves the NNU. Confirm correct tube position
    3. Remove any drug patches (eg Hyacine) from the skin
    4. Flush any necessary IV lines
    5. Place adhesive mini-muffs on both ears
    6. Remove any ECG stickers (if possible).  If necessary, MRI compatible ECG dots will be placed on arrival in the department.
    7. Wrap patient in a blanket

  9. Ensure resuscitation bag and transport incubator / pram is available with a full oxygen cylinder and a bag-valve mask of appropriate size. (note the pram / incubator cannot enter the MRI scan room)

  10. Ensure all staff accompanying baby do not have any contraindication to entering MRI room (see appendix) and have removed all metal objects from their person. If you intend to enter the magnet room, please leave valuables and belongings behind eg. Phones, keys, scissors, ID badges. Cards with magnetic strips (e.g. access or credit cards) should be left outside the scan room or they may be damaged. All staff should complete a screening form for themselves.

Transport to scan

  1. Confirm with MRI  60 minutes before scan that they are running to time.
  2. Administer chloral hydrate 30-40 mins before scan time
  3. Connect baby to unit portable saturation monitor
  4. Place baby in pram / transport incubator with blankets and allow to sleep. Staff must remain with patient from this point until returned from scan and fully conscious.
  5. Arrange porters in conjunction with MRI unit. If baby is unavoidably delayed notify MRI unit so they can scan another patient whilst waiting.
  6. 15 minutes before scan time set off to MRI unit- B floor, Clarendon Wing. Use the lift at the back of theatres on C floor.

In the MRI unit

  1. Report to reception on arrival. A member of MRI staff will double-check the safety of the baby and accompanying staff before entering our controlled area
  2. Transfer saturation probe to MRU unit saturation monitor and confirm working satisfactorily.
  3. Perform safety checks on baby and staff with MRI unit staff, and remove any final metal /magnetic objects.
  4. Carry baby to MRI table and position.
  5. Protect baby’s ears with muffs and place  head on moulding pillow (contains polystytrene balls). Shape pillow around head and suck out air to hold baby’s head in place
  6. Confirm saturations remain normal and continue to monitor continuously.
  7. NNU staff should follow the Radiographer into the control room to monitor the patient from there.  In some instances, it may be deemed necessary to monitor the patient from within the magnet room.  Ear protection will be provided for staff.
  8. Document saturations on baby chart at least every 5 minutes during scanning.

After the scan

  1. Carry baby out to pram / incubator
  2. Reconnect saturation probe to NNU monitor
  3. Return to NNU
  4. Keep baby on saturation monitor until fully recovered (minimum of 1 hour after return to unit)
  5. Do not feed by mouth until fully recovered and alert.

In the event of clinical deterioration or saturations <90% during the scan:

  • Ask staff to stop the scan
  • Assess patient: Check airway, breathing, circulation
  • If needs suction use MRI compatible suction device
  • If needs oxygen connect bag valve mask to MRI oxygen supply
  • If significant resuscitation needed remove patient from scan room to pram / incubator and call neonatal crash team

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Provenance

Record: 3893
Objective:
  • To standardise the safe care of newborns transported to the MRI unit for neonatal MRI scans
  • To optimize image quality and prevent the need for repeat scans.
Clinical condition:

Neurological disorders in newborn infants

Target patient group: Neonates (usually up to 3 months of age) at the LGI
Target professional group(s): Allied Health Professionals
Secondary Care Doctors
Adapted from:

Evidence base

BNFc, 2014: Dose and indication for chloral hydrate

Evidence levels:
C: NICE Guideline: Sedation in children and young people. 2010 http://www.nice.org.uk/nicemedia/live/13296/52124/52124.pdf
C. Expert consensus (Chloral hydrate used in many UK neonatal centres for this purpose)
D. Leeds consensus: Extensive experience of successful use of this sedation modality during neonatal MRI research programme (1996-2004)

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Approved By

Neonatal clinical governance group MRI anaesthetists

Document history

LHP version 1.1

Related information

Not supplied

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