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. Author manuscript; available in PMC: 2021 Jun 1.
Published in final edited form as: Int J Nurs Stud. 2020 Feb 22;106:103551. doi: 10.1016/j.ijnurstu.2020.103551

Table 2.

Summary of articles (n = 58)

Citation Sample Intervention Magnetic Resonance Imaging (MRI) Results (success rate measured by percentage)
Arthurs et al., 2011

Prospective cross-sectional, timeframe: not reported

United Kingdom
12 patients referred following first urinary tract infection or urinary tract abnormalities confirmed on postnatal ultrasound

Inclusion criteria: under 1 year of age
Infants wrapped in blanket and fed before or after MRI according to normal feeding schedule.

Pediatric nursing support provided.
Magnetic resonance voiding cystourethrography

Radiologist blinded to diagnosis determined if images were of diagnostic quality.
All examinations were diagnostically acceptable and completed within 60 min. (success rate = 100%).

Scan time = 36.6±13.0 minutes (range 20 – 60)

Ashley et al., 2005

Retrospective cross-sectional review of a radiology information system from Jan.–Nov. 2003

United States
53 patients with hydrocephalus, age 1– 22 years, 14 (21%) underwent more than one MRI

Exclusion: Images not available digitally
Not reported MRI of the brain

Radiologists determined if they were able to visualize the catheter.
In all cases, radiologists visualized ventricular catheter when present (success rate=100%).

Scan time = 22.5 minutes

Bartha et al., 2007

Prospective cross-sectional, stable inpatients scanned solely for research between July 2004 and October 2005

United States
16 healthy term neonates prospectively enrolled

Exclusion criteria:

Younger than 36 gestational weeks; suspected or confirmed metabolic disorder, congenital infection or malformation; signs of perinatal depression
Custom-built magnetic resonance compatible neonatal incubator and high-sensitivity neonatal head coil built to reduce patient motion, increase patient safety and comfort, and improve signal-to-noise ratio of the images.

Infants scanned immediately after fed.
Diffusion tensor imaging of the brain

Two experienced neonatal neuroradiologists assessed each scan separately for the presence and location of any signal intensity abnormalities and scored them using a previously validated MR imaging scoring system. Consensus was reached on all findings with an overall κ value of 0.9.
All images were assessable (success rate = 100%).

Scan time = not reported

Born et al., 2000

Prospective cross-sectional, time frame not reported

Denmark
7 infant patients born prematurely (n = 4), suspected of having visual functioning defects (n = 1), or had MRI for reasons unrelated to visual function (n = 2) did not receive sedation MRI performed during spontaneous sleep after feeding. Functional magnetic resonance imaging of visual system

Images were excluded if gross motion was present on the parameter plots, when there was visible motion on the cine loop of the time series, or when excessive motion artefacts in the typical localization appeared on the statistical map of a motion-corrected image.
8 of 31 (26%) acquired datasets were acceptable in the unsedated infants

Scan time = 4 minutes

Chateil et al., 1999

Prospective cross-sectional, timeframe: not reported

Location: France
30 newborn infant patients suspected of having birth or postnatal asphyxia and need for resuscitation after birth

Inclusion criteria: All infants suspected of suffered birth or post-natal asphyxia
MRI performed during natural sleep. MRI of the Brain

Images were determined to be invalid due to poor quality of the images and spectra due to head motion.
Image quality good in 25 of 30 newborns (success rate = 83.3%). Not possible to perform MRI during first hours of life or during critical early period in most severely affected infants. MRI not easily performed during first hours of life in infants with assisted ventilation or if infant weighed less than 2 kg. To study critically ill infants, necessary to use specialized non-magnetic incubator equipped with mechanical ventilation and complete system for physiological monitoring

Scan time = total imaging time was 20–90 minutes with an average of 1 hour

Damaraju et al.,2014

Prospective longitudinal MRI at 4 & 9 months of age, no timeframe reported

United States
Infants recruited from general pediatric clinics and community advertisements. All study participants born via uncomplicated term delivery without known medical or developmental disorders.

Exclusion criteria: genetic disorders, visual or hearing impairment
Imaging during natural sleep. Research assistant remained at infant’s side throughout MRI scan to observe movement and be immediately available if subject woke up. MRI of the brain

Images were used from infants who did not wake up or move during the scan.
At 4 months, of 84 infants imaged, 30 awoke prior to resting state MRI, leaving 54 completed MRI scans (success rate = 64.3%).

At 9 months, 23 of these 54 infants did not wake up or move during scan (success rate = 42.6%).

Total scan time = not reported

Dean et al., 2014

Prospective longitudinal January 2010 to April 2013

United States
Infants scanned at three 6-month intervals.

Initial scan: 148 infants

Follow-up scan #1: 83 infants

Follow-up scan #2: 33 infants

Follow-up scan #3: 10

Inclusion criteria: uncomplicated singleton birth between 37 and 42 weeks’ gestation with no physical MRI contraindications; no diagnosis of major psychiatric, depressive or learning disorders; no preexisting neurological conditions or major head trauma and no exposure to illicit drugs during pregnancy
Vacuum immobilization placed under infant before asleep. Once asleep, infant secured in immobilizer and transferred to scanner suite. Infant’s head positioned into head coil, headphones placed over infant’s ears and secured using foam cushions. Research assistant remained inside scanning suite in case child woke up during scan. Parents invited to remain in imaging suite during scan. MRI of the brain

Scans were deemed unusable due to image artifacts, i.e. intra-scan motion, off-resonance artifacts.
Success of scanning infants at initial visit = 95.9%.

Success of scanning infants at follow-up visits: 100%.

Scan time <30 minutes

Dean et al., 2017

Prospective cross-sectional

United States
149 infants were recruited based on the following criteria for the mother:

18 and 40 years of age, expecting singleton birth, no diagnosis of psychotic illnesses (i.e., schizophrenia, bipolar disorder, borderline personality disorder), no pre-existing neurological conditions or major head trauma, no major autoimmune disease or infections during pregnancy, and uncomplicated childbirth.

Exclusion criteria: any exposure to the neonatal intensive care unit (NICU) and if the infant did not go home with the mother at discharge.
Imaging was scheduled to correspond with the infant’s daily nap schedule after the infant was fed and swaddled. Infants were swaddled with a vacuum immobilization bag and foam cushions were placed around their heads to reduce intra-scan motion. A foam insert was fitted to the inside of the scanner bore, utilizing both malleable ear plugs and noise-attenuating ear covers, and using electrodynamic headphones that played white noise during the image acquisition. Diffusion tensor imaging; neurite orientation dispersion and density imaging

Images were used from infants who did not wake up during the scan.
33 infants woke up prior to and 13 infants woke up during the diffusion acquisition, resulting in a final study sample of 104 (success rate = 69.8%)

Scan time: 10 minutes

Fogel et al., 2011

Retrospective cross-sectional chart review from Jan. 1, 2005–Mar. 18, 2009

United States
24 patients, <6 months old investigated for aortic arch abnormalities

Exclusion criteria: tenuous respiratory status, more extensive imaging necessary, and parental instead of physician preference for type of imaging
Families instructed not to feed infants 2–3 hours before MRI. Ear plugs and hat placed over ears. Infant moved to room with lights dimmed; infant in mother’s or nurse’s arms, swaddled with blanket, and fed. Rocking and singing performed as needed. Once asleep, infant transferred to scanner, placed in supine position within head coil with supporting cushions. Angiography of the heart

The only criteria was that the image quality was great enough to obtain the diagnostic information.
One patient awoke during MRI. Examination of remaining 23 yielded a definitive diagnosis (success rate 95.8%).

Scan time = 6.2 ± 3.1 minutes

Foran et al., 2007

Prospective cross-sectional study, timeframe: not reported

United Kingdom
12 preterm infants, median gestational age 29 weeks (range: 26–33 weeks), median postconceptional age at the time of MRI was 33 weeks (range: 31–40 weeks)

2 infants had patent ductus arteriosus previously diagnosed, 10 believed to have structurally and functionally normal hearts

Inclusion criteria: preterm infants undergoing intensive care
Infants fed, allowed to fall asleep in quiet environment and laid in custom MRI-compatible cradle and placed in scanner with MRI-compatible physiologic monitoring and ear protection. MRI of the heart

Images had to allow for long-axis estimations
10 of 12 allowed image analysis (83.3% success rate).

Each scan lasted ~45 min.

Gale et al., 2013

Retrospective cross-sectional review of whole body MRI research without the use of sedation over the past decade

United Kingdom
Outpatient MRI of 457 infants (386 neonates, 71 infants ages 6–12 weeks) conducted for research purposes

Exclusion criteria: imaging solely the brain
MRI performed after infants fed, swaddled, placed in quiet, comfortable, private room with dim lighting, noise shielding (dental putty to ears before covering with earmuffs held in place with hat), and foam padding on infant’s head. Parents sat with research team. MRI of the whole body

Success rate was determined by obtaining good quality images free of movement artefact.
Achieved 94.0% success rate in obtaining diagnostic quality MRI scans.

Scan time = 9.26 – 17.42 with a median of 14 minutes

Golan et al., 2011

Prospective cross-sectional, all term patients who underwent imaging procedures during a non-specified 12 month period

Israel
40 patients examined, representing all imaging performed in 12 month period of data collection. Gestational age at birth was 27–40 weeks, examinations performed at ages ranging from delivery to 6 months old Infants fed, diaper changed, & placed in immobilizing device. Pacifier with or without sucrose given if needed. Parents strongly encouraged to join neonatal team to assist with cuddling. 15 CT scans, 25 MRIs of the brain, 1 bone scan

Images had to be considered qualitatively appropriate for interpretation by the radiologist on service.
100% success rate

Scan time = not reported

Gould et al. 2012

Retrospective cross-sectional review of MRIs performed over a 28-month period

United States
34 MRI studies performed on 24 patients with developmental hip dysplasia.

Exclusion criteria: No patient was scanned if underwent open reduction with internal fixation of the hip.
Not reported MRI of the hip

Review of all sequences was independently performed by 2 pediatric radiologists experienced in musculoskeletal MRI. Three criteria were used to evaluate the quality of the imaging: motion, tissue contrast, and spatial resolution. Scores were assigned on an agreed-upon scale (0, 1, 2), in which 0 was best and 2 was worst. For every sequence, average scores for each criterion and overall scores were calculated for each evaluator. If individual studies contained 1 or more attempts at a given type of sequence, the best of those repeated sequences was scored. Aggregate scores for each sequence type were also calculated.
33 of 34 MRIs were of diagnostic quality (97.1% success rate)

Scan time < 30 minutes

Groves et al., 2011

Prospective cross-sectional study of stable inpatients scanned solely for research, time frame not reported

United Kingdom
108 infants; 53 males, 74 on neonatal unit, 34 on postpartum unit, scanned at 26–42 weeks gestation Infants fed and allowed to fall into natural sleep, laid in MRI-compatible cradle. MRI of the Heart

Where possible scans were repeated using the initial imaging geometry (scan–rescan repeatability) after 5–15 min. Repeatability of analysis was also assessed from a single set of images by the same (intra-) and a different (inter-) observer. In all cases, observers were blinded to prior data when analyzing flow volumes.
100% success rate

Scan time = 45–60 minutes

Groves et al., 2012

Prospective cross-sectional study of stable inpatients scanned solely for research, timeframe not reported

United Kingdom
14 newborns

No inclusion/exclusion criteria reported.
Infants fed and allowed to fall into natural sleep, laid in MRI-compatible cradle. MRI of the Heart

The magnitude and phase images of each acquisition were assessed for image quality by a single observer using a subjective scale where 0 = unsuitable for analysis; 1 = acceptable for analysis, significant artifacts present; 2 = good image quality, almost no artifacts; and 3 = excellent image quality, no artifacts.
13 newborns had MRI scans of sufficient quality for analysis (success rate: 92.9%).

Scan time = not

reported

Haney et al., 2010

Design: Quality Improvement Project

Retrospective cross-sectional chart review of NICU patients undergoing MRI at one hospital Jan.-Dec. 2007

Prospective examination of NICU patients in MRI studies after implementation of new protocol designed to decrease or eliminate sedation with MRIs in Mar. 2009-Feb. 2010

United States
Retrospective: 154 patients born between 23–42 weeks

Prospective: 155 patients born between 23–42 weeks

No exclusion criteria reported
Retrospective:Prepared infant in radiology suite.

Prospective: Prepared infant in NICU and encouraged parental participation. Infants were swaddled, comforted and those tolerating enteral nutrition fed.

Swaddled infants placed in vacuum immobilizer and taken to MRI.
MRI of the brain 91% of the time. Additional body sites imaged included the spine, abdomen, chest, pelvis and multiple body sites.

Image quality was determined to be excellent, acceptable, poor, or unacceptable by the MRI technician at the time the imaging study was completed.
Retrospective: Achieved 3.9% success rate (6/154 = 3.9%) in retrospective design.

Prospective: Achieved 94.2% (146/155) success rate in prospective design.

Scan time = non-sedated patients were away from the NICU for 48 minutes

Hansen et al., 2009

Retrospective cross-sectional chart review of patients between Jan. 2005 to April 2006

Australia
36 patients age 3 days to 39 weeks

Inclusion criteria: pediatric patients scheduled for MRI exam without use of general anesthetic at one institution
Patients scheduled to arrive half an hour prior to scan after fasting for 4 hours. Infant fed until satisfied and nursed by family member or guardian to calm down. Infant escorted into scan room and positioned in beanbag. Air sucked out of beanbag and shaped to child’s body, maintaining good immobilization.

Family member or guardian stayed in scan room for duration of MRI to monitor the infant.
MRI of the brain

Image quality was assessed using three categories; good (no motion artefacts present), diagnostic (slight motion artefacts were seen but the radiologist was still able to answer the referring clinician’s questions based on the acquired images) or unsuccessful (substantial movement artefacts on the images or if the child could not be settled and immobilized in the beanbag).
32 out of 36 infants had good or diagnostic image quality (success rate = 88.9%).

Majority of scan times were < 15 minutes

Four patients did not complete scan: (3) did not settle after feeding (1) too large for immobilizer

Higano et al., 2017

Prospective cross-sectional, no time frame reported

United States
Five neonatal patients recruited from the neonatal intensive care unit (NICU) and primarily diagnosed with seizures or gastrointestinal issues, but with no suspected lung disease.

Five NICU patients with various pulmonary morbidities
Not reported Ultrashort Echo time MRI of lung parenchyma

Images from all five diseased subjects were evaluated by a radiologist with 22 years of experience and included classification of radiological findings within the ROI and degree of confidence in radiological assessment. All images were anonymized and evaluated in random order. (There was no mention of how the scans of patients without lung disease were evaluated.)
Success rate for patients with no suspected lung disease = 100% (Excluding one who received sedation for clinical purposes.)

Success rate for patients with lung disease = 80% (One received sedation specifically for the scan.)

Scan times 15–90 minutes.

Inder et al., 2005

Prospective cross-sectional study, between November 1998 to December 2000

New Zealand and Australia
129 consecutive premature infants with birth weight <1500g and gestation ≤ 32 weeks postconceptional age had MRI scan at term equivalent

21 random healthy term-born infants from same geographical sites
Infants fed and wrapped in bean bag. MRI of the brain

10 images could not be processed due to motion artifact (n=5), sequence errors (n=3), or registration difficulties (n=2)
119 (92.2%) infants had usable scans

Scan time = Not reported

Iskandar et al., 2004

Retrospective cross-sectional chart review of all patients who received brain MRI

April 2002–April 2003

United States
Seventy-two patients, birth to 62 years old (most children, median age 3.46 years) initially presented to emergency department or neurosurgery clinic with symptoms of shunt malfunction, total of 76 quick-brain MRIs acquired.

Inclusion criteria: MR imaging performed for symptomatic workup or asymptomatic follow up of shunt-treated hydrocephalus
Not reported. MRIs of the brain

Had to be able to see ventricular anatomy.
No image had movement artifact sufficient to obscure ventricular anatomy (success rate=100%).

Quick-brain MRI studies required a mean of 3.4 minutes to complete.

Jaramillo et al. 1998

Prospective cross-sectional study during an 18 Month period

United States
18 consecutive infant patients

Inclusion criteria: within 24 hours of hip reduction and spica cast placement
Imaged after discharge from recovery room from hip reduction and spica cast placement. Spica cast taped to imaging table to minimize motion artifact. MRI of the hip

One pediatric radiologist evaluated the images according to the following parameters: location of the hip, obstacles to reduction, gadolinium enhancement, and image quality.

For initial evaluation, the observer was unaware of the clinical information and all other imaging studies. In 14 infants, the MR findings were correlated with arthrograms obtained during reduction. On the images obtained after administration of gadolinium, 2 pediatric radiologists independently evaluated the pattern of enhancement and compared it with the angle of femoral abduction shown on the images.
Although some studies were degraded by motion artifact, enhancement and reduction could be assessed in all (success rate = 100%).

Scan time = 15 minutes

Knickmeyer et al., 2008

Prospective longitudinal, infants recruited during second trimester of pregnancy from outpatient clinic and scanned for research purposes shortly after birth, and at ages 1 and 2 years

No time frame reported

United States
153 infants initially scanned at 2–4 weeks

86 infants scanned at follow-up at age 1

67 infants scanned at next follow-up at age 2

Exclusion criteria:
Presence of abnormalities on fetal ultrasound or major medical or psychotic illness in the mother
Infants at 1 and 2 years mildly sleep deprived (i.e., parents asked to wake child 1 hour early and skip nap). Scans scheduled to coincide with child’s normal naptime or bedtime. Once asleep, fitted with earplugs or earphones and placed in MRI scanner with head in immobilization device and additional foam padding to diminish sounds of scanner. Neonatal scans performed with neonatal nurse present. For older infants, member of research team remained in scanner room to monitor child throughout scan. MRI of the brain

All scans were reviewed by an anatomical expert to determine if the results of the tissue segmentation were accurate. Segmentations for 5 of the 35 scans collected at age 1 were deemed poor quality. These scans were not included in the analysis of tissue volumes but are included in the analysis of ventricle, hippocampal, and caudate volumes. A single rater performed all segmentations for a specific structure. For the lateral ventricles, intrarater reliability was 0.99; for the caudate, intrarater reliability was 0.93; and for the hippocampus, intrarater reliability was 0.95. All reliabilities are intraclass correlations
Success of scanning at initial visit: 61.4%, follow-up 48.9%, next follow-up 52.2%

Total scan time = not reported

Laor et al., 2000

Prospective cross-sectional study between January 1999 to October 1999

United States
10 infants age 4–20 months referred for cross-sectional examination after intraoperative reduction for developmental dysplasia of hip and spica casting or recasting were performed. Each child imaged supine and feet first in MRI within 4 hours of surgery.
Infant scanned in between routinely scheduled patients.
All children restrained enough in spica cast to allow imaging up to several hours after reduction without additional sedation. Most fully awake, and several were crying. Parents or guardians were present in scanning room in all cases.
MRI of hip

Diagnostic images were deemed successful.
3 images moderately degraded by motion but all MRIs diagnostic and none had to be repeated (success rate = 100%)

Mean imaging time was ~ 3 minutes.

Lin et al., 2008

Design: Prospective cross-sectional study, no timeframe reported

United States
85 children: 38 neonates (2–4 weeks of age), 26 one-year-olds, and 21 two-year-olds

Inclusion: Birth between the gestational ages of 35 and 42 weeks, weight appropriate for gestational age

Exclusion criteria: maternal pre-eclampsia, placental abruption, neonatal hypoxia, or any neonatal illness requiring >1-day stay in NICU; mother with HIV; any mother actively using illegal drugs/narcotics during pregnancy; or any chromosomal or major congenital abnormality
All subjects imaged asleep. Functional MRI of the brain

Images were excluded due to motion artefact.
14 infants met exclusion criteria (2 neonates, 6 one-year olds, & 6 two-year olds) and were excluded from final data analysis (85– 14=71)

Motion artifacts were observed in 32 additional infants; 18 neonates, 6 one-year-old and 8 two-year-olds.

As a result, 39 infants (18 neonates, 14 one-year-olds, and 7 two-year-olds) were included for final data analysis (39/71=54.9% success rate). Scan time = Not reported

Liu et al., 2008

Design:

Prospective cross-sectional study, part of a larger longitudinal study, participants recruited 2002–2005

United States
11 full-term, normally developing, healthy infants (mean age 12.8 months)

Inclusion criteria: Drawn from larger study, 59 scans acquired after 94 attempts (63%). Of 59 scans, 17 included both structural and functional data. Of 17, 11 full-term, normally developing, healthy infants.
Infants scanned in evening near normal bedtime. Parents encouraged to omit afternoon naps. Scanning suite setup with crib, rocking chair, lullaby music and lights dimmed. Mothers nursed or fed infant. After infant asleep, placed on scanner bed. MRI of the brain

Seven subjects had movements of less than 0.1 mm; three subjects had head motions greater than 0.1 mm but less than 1 mm; and one subject showed head motion greater than 2 mm but less than 3 mm. The motion correction was applied to all the data and for the subjects with >1 mm head movement, data subsets were removed within the run to correct for the motion artifacts. After the motion correction, all data contained only movements that were under 0.1 mm.
After motion-correction, all scans were usable (success rate=100%).

Scan time = 5 minutes

Maas et al., 2004

Prospective cross-sectional study, timeframe not reported

United States
2 extremely premature infants born at estimated gestational ages of 24 and 25 menstrual weeks. Estimated ages of patients at time of scanning were 25 and 27 menstrual weeks, or 23 and 25 post-ovulatory weeks, respectively. Not described. Diffusion tensor imaging of the brain

How success was defined was not reported.
100% success

Scan time = not reported

McKinstry, Mathur et al. 2002

Prospective longitudinal study with preterm patients recruited from NICU and special care nursery, no time frame reported

United States
38 scans total

24 patients imaged within first 36 hours after birth

14 scanned again prior to discharge from hospital

Inclusion criteria:
Gestational age ranged from 26 to 41 weeks and was average of mother’s last menstrual period, patient’s Ballard score and fetal ultrasound if available. Infants whose MR scan prior to discharge included if no known complications during hospital course that would cause cortical injury.

Exclusion criteria:
Gestational age estimates did not agree within 1 week, evidence of drug exposure in utero, brain injury, significant hypoxia, severe respiratory distress, congenital malformations, or infants on continuous positive airway pressure.
Infants swaddled in warm sheets/blankets, placed on scanner table on MR-compatible chemical heating pad and heads restrained with soft cushions. Diffusion tensor imaging of the brain

All ROI placements were verified by a CAQ-certified neuroradiologist and a board certified pediatric neurologist. Images had to be sufficiently free of movement artifact to allow for analysis.
28/38 had usable scans (no mention of whether these were the first or second scan) Success rate = 73.7%

Scan time = 40 minutes

McKinstry, Miller et al. 2002

Prospective longitudinal study, newborns imaged day 1, 3 & 7 of life between November 1997 to October 2001

United States
12 newborns recruited from NICU.

Inclusion criteria:
Term infants following uncomplicated pregnancies with clear-cut event near birth that could be timed accurately and likely to cause brain injury, such as tight nuchal cord at delivery, shoulder dystocia, skull fracture, and uterine rupture with placental abruption. All infants had depressed level of consciousness and a disturbance of muscle tone (typically hypotonia), indicating encephalopathy.

Exclusion critera:
Infant too unstable to transport to scanner or identified after first day of life.
Infant swaddled in warm blankets, and knit cap placed on head. Diffusion Tensor Imaging of Brain

Each ROI placement was verified by a CAQ-certified neuroradiologist (who was blinded to the patient’s history, all the imaging studies obtained earlier, and the diffusion scans) and a board-certified pediatric neurologist. Images were considered successful if the quality was sufficient to allow for analysis.
One patient excluded due to excess motion artifact. Since it was not stated if the patient was excluded at day 1, 3 or 7, an assumption is made that patient was excluded at day 1.

Day 1: 11/12 infants had usable scans:
91.7% success rate
Day 2: 11/11. 100%
Day 3: 11/11, 100%

Scan time = 40 minutes

McNally et al., 1997

Prospective cross-sectional,13 consecutive patients over a 20 month period (specific timeframe not reported)

United Kingdom
13 patients

Inclusion criteria: after reduction of developmental dysplasia of the hip
Hip held in place with spica cast. MRI of the hip

Definition of success not reported.
All scans adequate, although 4 required a 2nd sequence. (100% success rate)

Scan time = not reported

Merchant et al., 2009

Prospective cross-sectional over a 20 month time period between 2007–2008

United Kingdom
72 preterm infants weighing less than 1500 g were recruited over a 20 month period (2007–2008).

Exclusion criteria:
Attending neonatologist judged infants too unstable to transfer to imaging suite.
Infants given milk feeding prior to scanning. Infants receiving parenteral nutrition receive equivalent volume given as 10% glucose with additives as appropriate for the duration of the scan. Infants placed in two layers of clothing and plastic wrap prior to transport to MRI scanner room, swaddled with prewarmed sheets encouraged sleep, and reduce movement. Moldable dental putty applied to ears and covered with neonatal ear muffs. Hat applied over ear muffs. Vacuum bag covered with muslin cloth and wrapped around the baby’s head. Foam insertions between the vacuum pack and coil. MRI of brain

The definition of successful image acquisition was not reported.
70 underwent successful image acquisition (success rate = 97.2%).

Median scan time = 55 minutes

Miller et al., 2007

Design: Prospective cross-sectional between September 2001 to July 2005

United States
41 term newborns with congenital heart disease

Exclusion criteria:

gestational age at birth < 36 weeks or if suspected congenital infection or genetic malformation syndrome

16 control newborns of similar gestational age

Inclusion criteria: no signs of perinatal illness or major malformations (e.g., congenital heart disease)
Infants imaged in MRI compatible neonatal incubator MRI, magnetic resonance spectroscopy and diffusion tensor imaging of the brain

A neuroradiologist who was unaware of all clinical information except for age and cardiac diagnosis scored each MRI scan for acquired focal, multifocal, or global changes.
100% success rate

Scan time = Not reported

Missios et al., 2008

Design:
Retrospective cross-sectional chart review of 1146 Brain MRIs from Feb 2003–Dec 2007 and prospective review of 457 “quick brain” MRI studies (no time frame reported).

United States
457 imaging scans done in 346 patients ages 1 day to 78 years old (mean age 4.1 years, median age 21.9 months)

Inclusion: Macrocephaly, Chiari malformation, intracranial cyst, screening prior to lumbar puncture for intracranial pathological conditions associated with increased intracranial pressure, screening for congenital anomalies, trauma, and suspected intracranial pathological conditions in the presence of neurological symptoms such as seizures

Exclusion: Patients undergoing imaging for known hydrocephalus or shunt follow-up
Parents/family members of infants or staff assisted by holding infant’s head in place during MRI MRI of the brain

Success rate not defined.
Success rate = 100%

Scan time < 2.5 minutes

Modi et al., 2001

Prospective cross-sectional study with control group

Timeframe not reported

United Kingdom
16 patients were imaged as soon after delivery as possible.

10 patients exposed to repeated antenatal glucocorticoid therapy born at or close to term

6 patients who were not exposed to antenatal glucocorticoid therapy born at term
Infants imaged in normal quiet sleep, as soon after delivery as possible within 1 week of birth. MRI of the brain

All analyses were performed blinded to patient group. All 16 infants showed normal brain anatomy.
All MRIs were usable (success rate=100%).

Scan time = Not reported

Neil et al., 1998

Prospective cross-sectional study, timeframe not reported

United States
28 healthy newborn patients 31–41 weeks gestational ages

Inclusion criteria: unremarkable pregnancies

Exclusion criteria: movement artifact, questionable gestational age, seizures
Some given bottle 30– 45 min. before imaging, all swaddled with head restrained cushions Diffusion tensor imaging of the brain within the first 36 hours of life

Some movement artifact was tolerated as long as anatomic structures could be reliably identified.
22 images usable (12 term and 10 preterm, success rate = 78.6%)

Scan time = 30–40 minutes per patient

Neubauer et al., 2011

Prospective cross-sectional study between October 2007 and May 2010

Austria
56 preterm infants born before 32 weeks gestational age & admitted to the NICU

Inclusion: Patients born at one hospital before 32 weeks gestational age and admitted to the neonatal intensive care unit
Infants fed 20 to 30 min before scan, fitted with earmuffs, swaddled and laid on vacuum cushion. Parents accompanied infant and rocked infant to sleep if necessary. Pacifier & orally administered glucose solution used if necessary. MRI of brain around term-equivalent age

The radiologist in charge of the study was available to evaluate the quality of the scan during the examination. In the case of poor-quality images because of movement artefacts, the MR examination was interrupted at any time.
52 of 56 MRI scans completed successfully (success rate=92.9%) 39 of 56 (69.6%) accomplished without delay. 17 (30.4%) interrupted because infant agitation or crying; these included 4 (40%) interruptions in in-patient and 13 (28.3%) in out-patient infants. Of these 17 infants, 13 (76.5%) calmed during acceptable time and high-quality images still achieved.

Mean duration of all sessions = 36 ± 14 min.

MRI session in out-patient infants concluded within 32 ± 12 min, while mean duration with in-patients was 54 ± 10 min (p < 0.01, n = 46 and 10).

Nossin-Manor et al., 2013

Prospective longitudinal MRIs acquired between March 2008 and April 2010 as part of broader cohort of prospective longitudinal study.

Canada
54 preterm neonates born 24–32 weeks gestational age scanned within 2 weeks of birth and 31 scanned for second time at term equivalent age between 36 and 45 weeks gestational age

Exclusion criteria:
Grade III and IV intraventricular hemorrhage and ventriculomegaly
Not mentioned MRI of the brain

Images free of motion artifacts were retained for analysis.
44 of 54 preterm scans were usable (success rate = 81.5%)

17 of 31 term equivalent age scans were usable (success rate = 54.8%)

Total scan time = 28 minutes

O’Regan et al. 2012

Design:

Retrospective cross-sectional chart review of brain MRI during 2 year period: December 2006–December 2008

Ireland
49 term and preterm neonates

Group A: Imaged prior to introduction of MR-compatible incubator using standard MR sequences and equipment (knee coil)

Group B: Imaged using MR-compatible incubator and standard MR sequences

Group C: Imaged using MR-compatible incubator and modified MR sequences

Inclusion criteria: term or preterm neonates who received MRI at one institution during a 2 year time period
Neonates imaged after feeding with attention to swaddling and stabilization with head coil. MRI of the brain

Subjective and objective measures of image quality were assessed by two radiologists who were blinded to patient details and to whether the patient was scanned using standard equipment or using the MR-compatible incubator. First, overall image quality was assessed on a 3-point rating system based on image sharpness and clarity of the grey–white matter interfaces. Second, it was documented whether motion artefact was present or absent on the examination in any of the sequences.
10 patients excluded for incomplete examinations and non-standard MR parameters

# of patients with usable scans: Group A: 8 out of 15 (53.3%) Group B: 10 out of 15 (66.7%) Group C: 8 out of 9 (88.9%)

Mean scan time:
Group A: 14 min
Group B: 15 min
Group C: 17.5 min

Partridge et al. 2004

Prospective longitudinal study of over 28-month duration (between November 8, 2001 and March 5, 2003), 50 premature neonates imaged.

United States
15 premature neonates met inclusion criteria. Patients first imaged between 28 and 39 weeks gestational age (median, 33 weeks), and 8 received second imaging at or near term age or just before discharge from hospital

Inclusion criteria:
Neonates born at gestational ages of 24 to 36 weeks with no evidence of white matter injury on conventional MR imaging.

Exclusion criteria:
Greater than Grade 1 hemorrhage (i.e., small intraventricular bleed confined to the subependymal region), congenital infection, brain malformation, or a multiple congenital anomaly syndrome.
Cotton ear muffs, comfortable contoured padding, warm environment, double-walled construction, and acoustic and vibration damping all tend to facilitate undisturbed sleep and/or calm resting during scans. Diffusion tensor imaging (DTI) of the brain
Images were excluded if motion artifacts substantially degraded the DTI acquisition.
2 scans excluded from one patient due to motion artifact

14/15 at time 1 = 93.3%
7/8 at time 2 = 87.5%

Total scan time = not reported

Rabattu et al., 2014

Retrospective cross-sectional chart review, no timeframe reported

France
9 patients required MRI for lower limb disorder

Inclusion criteria: requiring spica cast immobilization
Temporary spica cast immobilization, parents stood close to their child during the whole examination MRI of lower limb

All MRI were examined by a consultant radiologist to determine whether the diagnosis could be reached or if the rate of movement artifacts were too numerous, hampering clinical scan interpretation.
Although 2 of 9 infant MRIs had artifact, diagnosis achieved in all cases = 100% success rate.

Scan time = not reported

Reilly et al., 2012

Retrospective cross-sectional chart review, descriptive, comparative study conducted through auditing neonate and infant charts with completed MRI brain with sedation or with the use of an immobilizer between 1/1/2007 – 9/30/2010

United States
36 patients did not receive sedation

Inclusion criteria: less than or equal to 90 days of age, weighing at least 2 kg, required MRI brain scan that was predicted to take no more than 60 min to complete

Exclusion criteria: patients weighing less than 2 kg with a post-conceptual age greater than 3 months, artificial airway or mechanical ventilator support, umbilical catheter, or were unable to be fed orally or enterally
Non-sedated patients fed and placed in infant immobilizer prior to MRI. MRI of the brain

Final radiology reports were obtained from the patient’s medical record. Reports indicated diagnostic quality of the images obtained based on interpretation by the radiologist.
Images considered diagnostic in 94.4% of non-sedated infants (34 out of 36)

The scans were ≤ 60 min.

Rozovsky et al., 2013

Retrospective cross-sectional radiology chart review between January 2008 and August 2010

Israel
30 patients age 1 day to 5 years (mean: 18 months)

Inclusion criteria: Scan performed to assess shunt position, size and configuration of fluid-filled structures

Exclusion criteria: MRI performed in patients older than 5 years, those performed under general anesthesia or sedation at any age, and studies performed for clinical indications other than assessment of the ventricular system and extra-axial cerebrospinal fluid paces
Not reported. MRI of the brain

Images were reviewed in detail by a clinical fellow with 5 years’ experience in pediatric radiology and a pediatric neuroradiologist with 10 years’ experience in pediatric radiology & 4 years’ experience in neuroradiology. Radiologists had knowledge of the clinical indications for each study but were blinded to previously reported findings. Their interpretations were subsequently compared to findings reported in Picture Archiving and Communication System. All studies were compared to the most recent MRI or CT study, which served as a reference standard. Disagreements between readers and between the new interpretation and original report were resolved in consensus.
All brain MRIs provided satisfactory answers to the clinical question (100% success rate).

Scan time = not reported

Rutherford et al., 2004

Prospective cross-sectional study of infants delivered at >36 weeks’ gestation and presented with seizures in first 72 hours after delivery.

Group 1: Infants with neonatal encephalopathy

Group 2: Infants who did not have criteria for neonatal encephalopathy as outlined above.

Control Subjects Fifteen infants with normal brain imaging and normal neurologic examination

Timeframe: Not reported

United Kingdom
63 patients in group 1

14 patients in group 2

15 infants in control group

Inclusion criteria for groups 1 & 2: Delivered at >36 weeks gestation and presentation of seizures within 48 hours post-delivery.

Additional inclusion for group 1: Neonatal encephalopathy, abnormal tone patterns, feeding difficulties, and altered alertness and at least 3 of the following: 1) late decelerations on fetal monitoring or meconium staining, 2) delayed onset of respiration, 3) arterial cord blood pH <7.1, 4) Apgar scores <7 at 5 minutes, and 5) multi organ failure.

Additional inclusion criteria for group 2: Seizures within 72 hours of birth but no neonatal encephalopathy

Additional inclusion criteria for control group: No resuscitation at birth, normal Apgar scores, and no seizures or other clinical neurologic symptoms

Exclusion criteria: evidence of metabolic disease, congenital infection, major malformations, alcohol or drug embryopathies, hydrops, chromosome abnormalities, brain damage on initial scan or evidence of developmental abnormalities
Groups 1 & 2: Infants examined during natural sleep or after feed

Control group: Infants examined during natural sleep
Diffusion weighted imaging of the brain

Analysis of the DWI was undertaken by 1 experienced researcher.
All scans usuable (success rate=100%).

Scan time = not reported

Ryan et al., 2016

Retrospective cross-sectional chart review from 2009 through 2013

United States
61 patients (range 1 day to 22 years, mean age 2.4 years) with a prior CT, either at this institution or another institution, loaded onto a digital picture archiving and communications system workstation within 48 h of rapid MRI

Patients were excluded in cases of interval neurosurgical procedure, inadequate CT imaging, or no identifiable hemorrhage by CT.
None reported MRI of the brain

Imaged were anonymized, and reviewed by two board certified pediatric neuroradiologists. Motion degradation scored from none (0) to severe (3).
Success rate = 100%

Scan time = not reported

Sigmund et al.,1991

Prospective cross-sectional study between Sept. 1989 to Nov. 1990

Germany
9 infant patients

Inclusion criteria: suspected morphologic pathology of kidneys and urinary tract
Infants fed. MRI of urinary tract

The quality of the images were subjectively classified as excellent (no motion artifacts & a high signal-to-noise ratio), satisfactory (motion artifacts & considerable noise but images were still diagnostic) and poor (non-diagnostic).
All images diagnostic (success rate = 100%).

Scan time = not reported

Siles et al., 2014

Prospective cross-sectional study between December 2008 to October 2010

France
16 full-term neonates and infants younger than 3 months and without any clinical or biological anomaly suggesting cholestasis. Eight of the 11 were scanned after their usual milk feeding and gentle swaddling, which spontaneously rendered them calm or asleep; the other three were examined after 3–4 h fasting, gentle swaddling, and rocked to sleep. All were restrained in a plastic cast with arms resting against their sides. MRI of the brain, orbit or face

Images were read jointly by two experienced pediatric radiologists (6–15 years of practice) and a junior radiologist with 6 months of training in Pediatric Radiology. Case inconsistencies were discussed during the readings in order to reach a consensus.
Performed 11 out of 16 exams without sedation (success rate = 68.8%).

The acquisitions’ duration ranged from 2 minutes 30 seconds to 8 minutes 15 seconds (mean 5 minutes 20 seconds, median 4 minutes 50 seconds).

Sirin et al., 2013

Retrospective cross-sectional chart review between February 2011 to May 2012

Germany
8 patients were scanned without sedation

Inclusion criteria: All infants who received a MRI of the brain on a 3 Tesla MR scanner
All infants fed prior to MRI. Mini muffs and molded ear plugs from silicone-based putty used for noise reduction. MRI of the brain

Images that had motion artifacts with relevant impairment of image quality were considered unusable.
6 out of 8 scans without sedation were usable (success rate = 75%)

Mean scan time 34 min (standard deviation 20 min, range 12–71 min).

Smyser et al. 2010

Prospective longitudinal study of preterm infants aged 26 weeks postmenstrual age (PMA) through term equivalent PMA recruited from well-baby nursery and NICU as part of ongoing study.

Initial image acquisitions performed within first 2 weeks of life (as early as 26 weeks PMA). Based on clinical status and gestational age at time of delivery, serial data sets for each infant collected ~ every 4– 5 weeks (30–31, 34–35, and 38–40 weeks PMA).

Data from 10 term control infants (4 males) collected within 2–3 days of birth.

No time frame reported

United States
90 data sets collected from 53 preterm infants Infants studied during natural sleep or resting quietly in scanner. NICU staff member present in scanner room throughout each acquisition. MRI of the brain

Images with excessive motion artifact were removed.
10 datasets excluded due to excessive motion at varied stages of acquisition. Success rate = 80/90 = 88.9%

Total scan time = 50 minutes

Spann et al., 2015

Prospective cross-sectional study between 2005–2009

United States
37 healthy infants

Inclusion criteria:
maternal age at conception of 18– 45 years, no major prenatal or delivery complications, gestational age ≥ 37 weeks, birth weight >10th percentile relative to the national standards, no major congenital anomalies, and an uncomplicated neonatal nursery course.

Exclusion criteria: maternal history of a chronic medical disease, used drugs of abuse, smoked cigarettes, or drank more than 1 ounce of alcohol during any trimester.
Infants were fed, swaddled, and given time to fall asleep. Foam ear plugs along with ear shields were applied to dampen scanner noise. Infants were acclimated to the scanner environment and noise before the start of scanning. MRI of brain

Operators were blinded to infant characteristics. The operator interrater reliability was assessed on 10 scans with intraclass correlation coefficients > 0.95.
Success rate = 100%. However, these infants were a subset of participants in a larger study.

Scan time = not reported

Thomeer, et al.,2015

Prospective cross-sectional study between 2008 and the first half of 2014, all patients born in one institution

Netherlands
36 patients admitted for anorectal malformation in postnatal period

Inclusion criteria: neonatal period up to 4 months after birth.

Exclusion criteria: 3 excluded for only one examination performed (either MRI or colostography/fistulography)
Infant patients fed and wrapped prior to imaging. The majority of infants sleeping during imaging. MRI of pelvic floor

The MRI studies were prospectively and independently analysed by two readers (two experienced staff members of paediatric radiology and abdominal radiology), blinded to the results of surgery.
One MRI unsuccessful yielding success rate of 32/33= 97.0%.

Scan time = not reported

Tkach et al., 2014

Prospective cross-sectional study, time frame not reported

United States
15 neonates

Inclusion criteria: medically and thermally stable (not recruited on the basis of a suspected or known clinical need)
Fed 1 hour prior to MRI. Fussy infants received 25% sucrose solution immediately before and, if needed, during the imaging. 15 MRIs of the brain, 7 MRIs of the abdomen, 6 MRIs of the chest, 2 MRIs of the heart

The images obtained of the brain, chest, and abdomen were reviewed by board certified pediatric radiologists with additional expertise in neuroradiology and body MRI, respectively. The cardiac images were evaluated by a pediatric cardiologist experienced in cardiac MRI. In all cases, the evaluation was subjective. Each dataset was assessed for overall study quality (limited, adequate, or good), motion (none, moderate, or significant), spatial resolution (poor, moderate, or excellent), SNR (poor, moderate, or excellent), and contrast (poor, moderate, or excellent) as compared with similar neonatal examinations performed on conventional MR scanners in same institution.
All infants participated in single session without sedation (success rate = 100%).

No imaging session ended prematurely.

7 of 15 subjects had significant motion during imaging necessitating temporary suspension of scanning to calm infant by re-swaddling, administering 24% sucrose solution, or both. MRI was resumed and successfully completed after each intervention.

For infants not responding to feed-and-swaddle method, fast imaging techniques used, proving successful in providing diagnostic information even in presence of significant intermittent motion.

Total scan time = limited to 60 minutes

Tsiflikas et al. (2019)

Retrospective cross-sectional review of all functional MRI urographies performed in infants younger than 1 year in a radiology database at one institution between 2010 and 2017

United States
42 infants younger than 1 year

No additional inclusion or exclusion criteria noted
Infants scheduled for a feed-and-sleep examination were deprived of sleep and were fasted for 4 h before MRI scan. Each child was fed just before the scan Functional MRI urographies

Evaluated by a pediatric radiologist and by a pediatric surgeon (both with more than 10 years of experience in MRurography) in consensus using a 3-point scale for motion artifacts (1: no artifacts visible; 2: moderate artifacts without hampering the diagnostic quality; 3: marked artifacts hampering the diagnostic quality).
In the feed-and-sleep group, 38 of 42 examinations (90%) were completed successfully.

Scan time = mean of 28 minutes

Walkup et al., 2015

Prospective cross-sectional study, timeframe not reported

United States
18 infants were divided into three subgroups:
Full-term control group (n = 6), defined as NICU patients born at greater than or equal to 36 weeks gestational age without major, suspected pulmonary complications
Premature non-bronchopulmonary dysplasia group (n = 6), defined as birth at less than 36 weeks gestational age

Premature infants with clinical diagnosis of bronchopulmonary dysplasia (n = 6)
Infants fed, swaddled, and equipped with ear protection before imaging. MRI of lung parenchyma

MRIs were clinically scored by a radiologist with no prior knowledge of clinical diagnosis using a modified Ochiai scoring system with a higher score reflective of more severe findings (range, 0–14); the radiologist also scored the diagnostic quality of the images (0–2, with 0 considered nondiagnostic quality).
All 18 infants participated in single imaging session without sedation (success rate = 100%).

Scan time = 1 hour for preparation and scanning. 30 minutes for localization and acquisition

Wang et al., 2008

Prospective cross-sectional study, time frame not reported

United States
Normal infants, 19 infants imaged at 7 or 13 months of age studied at single site

No additional inclusion or exclusion criteria noted
Infants fed and allowed to fall asleep. Foam padding restricted head movement and provided sound attenuation. Arterial spin labeled perfusion MRI of brain

CBF maps showing spuriously low values (<20 ml/100 g/min for whole brain) suggested ineffective labeling and were discarded.
Acceptable cerebral blood flow data obtained from 8 infants aged 6.9 ± 0.2 months and 8 infants aged 12.7±0.2 months, corresponding to a success rate of 84%.

Total Scan time = Not reported

Whitby et al., 2004

Prospective cross-sectional study, time frame not reported

United Kingdom
7 stable neonate patients born from 24 weeks gestation to term were imaged at age 2 days to 4 months in custom-built incubator before discharge home from unit

Exclusion criteria: none reported
None mentioned. Diffusion weighted imaging of the brain

The images were scored for quality by 2 neuroradiologists and 1 neonatal radiologist, and a radiologic diagnosis was reached by consensus in each case.
100% success rate

Scan time = 10–21 minutes

Whitby et al., 2003

Prospective cross-sectional double blind trial, time frame not reported

United Kingdom
134 neonatal patients

Group 1 (control): 89 neonates with no known neurological symptoms and not expected to have intracranial disease (40 preterm & 49 term)

Group 2: 43 neonates with known or suspected intracranial pathology on clinical grounds (23 preterm & 20 term)

Exclusion criteria: none noted
Neonates swaddled in blanket MRI of brain

Images were independently reviewed for pathology by two experienced radiologists who were blinded to the ultrasound results. Results are expressed according to whether they agreed with the ultrasound findings and whether this altered clinical management of the infant.
Group 1: 87/89=97.8% success rate for neonates with no known neurological symptoms

43 of the MRIs from neonates with known or suspected intracranial pathology were reportable (success rate = 100%).

Typical time in the scanner was 30–40 minutes.

Windram et al.,2012

Retrospective cross-sectional review of 20 consecutive patient charts between January 2010 to January 2011

Canada
20 patients younger than 6 months requiring cardiovascular MRI who received no sedation

Inclusion criteria: <2 years old
“Feed and sleep” method: fasting infant for 4 hours prior to scan and feeding just prior to scan, earmuffs, immobilizer, dim lighting, extra feed if infant awoke MRI of the heart

Images had to be of sufficient quality to provide a diagnosis.
Achieved 100% success rate.

The median time was 46.5 min (range 20 to 66 min).

Woodward et al. 2006

Prospective cross-sectional study of 1 hospital in Christchurch, New Zealand (November 1998 to December 2000) and 1 hospital in Melbourne, Australia (July 2001 and May 2002)
167 very premature infant patients born ≤30 weeks gestation

Exclusion criteria: 1 blind infant and 2 infants with incomplete data
Infant fed, wrapped and placed in beanbag. MRI of brain

All scans were scored independently by one of the authors and by a pediatric neuroradiologist (Christchurch) or neonatologist (Melbourne). Raters were unaware of the infants’ perinatal history and ultrasonographic findings. A standardized scoring system developed in this study was used, consisting of eight 3-point scales.
All usable scans (100% success rate).

Total scan time = not reported

Young et al., 2016

Retrospective cross-sectional chart review of emergency department at one institution between January 2010 and May 2015

United States
33 patients age ≤ 6 years with head trauma and received a rapid non-sedated MRI within 24 hours of injury Parent or caregiver accompanied child into the MRI room and laid with the child on the scanner table so that the caregiver could provide reassurance to child throughout the scan. The caregiver held the child’s head between her or his hands for additional tactile reassurance and to aid in control of head motion while the technologist placed the coil over the child’s head. The child and parent/caregiver were moved into the scanner bore together and the scan was performed. MRI of the brain

The scans were de-identified and reviewed independently by two board-certified neuroradiologists.
All usable scans (100% success rate).

Total scan time for the four core sequence protocol was 1.5 to 2 min. Additional sequences were obtained if requested by the radiologist or treating physician and if tolerated by the child (scan times not reported).