Non-pharmacological strategies to obtain usable magnetic resonance images in non-sedated infants: Systematic review and meta-analysis.
Elisa R Torres, Tyler A Tumey, Douglas C Dean and 3 others
PMID 32294563WHAT IT FOUND
Non-sedated infants could often have usable MRI scans using feeding, swaddling, sleep, immobilizers, ear protection and parent presence.
Pooled success was 87% with an average scan time of 30 minutes, but results varied widely, especially in at-risk infants needing brain structural scans.
Key findings
01Pooled across 53 articles and 3,410 infants, non-pharmacological strategies alone obtained usable MRI scans in 87% of infants (95% CI 0.83 to 0.91).
02At-risk infants had usable scans 4-100% of the time, averaging 67.9%, while healthy infants had usable scans 48.9-100% of the time, averaging 84.6%.
03Most articles that reported how infants were kept still used a combination of feeding or swaddling, an immobilizer, ear muffs and imaging during sleep; usable scans were obtained 4-100% of the time, averaging 88.1%.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
There was no standard way to decide if a scan was usable, so one study's failure could be another study's success. The review included studies regardless of risk of bias, and all studies had selection bias because infants came from particular facilities and reasons for imaging. Heterogeneity was very high, with I2 = 98.30%, so the pooled 87% is an average across very different infants, techniques, countries and outcome definitions. The prospective cross-sectional subgroup showed funnel plot asymmetry, suggesting publication bias. Many articles did not report scan time or how infants were kept still, and some did not state how many infants were in the sample or based success on scans rather than infants. Only English articles were included, and most studies were structural brain MRI. This restricts generalizability to other languages, body parts and scan types. Six articles did not report consent or ethics approval, and thirteen did not clearly state an experimental hypothesis.
Declared interests
The authors declared no competing financial interests or personal relationships and reported no conflict of interest.
The easy way to misread this
Do not read the pooled 87% success rate as proof that every non-sedated infant will get a usable MRI. The studies were very heterogeneous, at-risk infants had success rates of 4-100% averaging 67.9%, and the prospective cross-sectional subgroup showed publication bias.