In ventilated babies requiring MRI, when feed and wrap technique is not effective resulting in motion artefacts affecting image quality, what is your experience with using sedation such as buccal midazalam.

We published our experience just recently using buccal midazolam. See below

Daoud G, Karayil Mohammad Ali S, Chakkarapani AA, Durrani NUR. Intervention Bundle for Optimization of Procedural Sedation for Newborns Undergoing Magnetic Resonance Imaging: A Single-Center Quality Improvement Project in Qatar. Biomed Hub. 2024 May 22;9(1):73-82. doi: 10.1159/000538762. PMID: 39015198; PMCID: PMC11249786.

We often use intranasal midazolam for MRI sedation, including in non-ventilated infants. Non-pharmacological methods like swaddling and feeding are sometimes insufficient. Radiology had suggested intubating all infants for MRI, which we felt was impractical and not fair for the babies. Intranasal midazolam has been our compromise.

Generally, it’s effective, but we’ve noted occasional myoclonus. Providers should be aware of this and not overreact. In one case, an infant became overly sedated and required PPV. It’s important to have clear protocols—e.g., initiate PPV for desaturation and consider activating the rapid response team as needed.

Our strategy, in addition to feeds and swaddling, we give kloralhydrat 25-50 mg/kg orally/enterally (if NG). In addition, we always have a periph ven cannula and give midazolam iv if needed.

Se il neonato è intubato e ventilato, solitamente ha già una sedazione adeguata in atto. Nei neonati in respiro spontaneo, oltre a misure di care, usiamo midazolam per via orale o nasale. Non abbiamo mai avuto effetti collaterali

If the newborn is intubated and ventilated, he or she usually already has adequate sedation in place. In spontaneously breathing newborns, in addition to care measures, we use oral or nasal midazolam. We have never had any side effects.

Edited April 5Apr 5 by 99nicu.org
Added English translation