Feed and Swaddle: An Alternative to Infant Sedation for Craniofacial Imaging. (November 2019)

• Record Type: Journal Article
• Authors: Esmonde, Nick; Jedrzejewski, Breanna; Fitzpatrick, Beth; Koh, Jeffrey; Bardo, Dianna; Urbinelli, Leo; Crupi, Lisa; Oliverio, Maureen; Selden, Nathan R.; Kuang, Anna
• Is Part Of: Cleft palate-craniofacial journal. Volume 56:Number 10(2019)
• Page Start: 1373
• Page End: 1376
• Publication Date: 2019-11
• Subjects: craniosynostosis -- craniofacial -- pediatric sedation; Cleft palate -- Periodicals; Skull -- Abnormalities -- Periodicals; Cranial manipulation -- Periodicals; Skull -- Abnormalities -- Surgery -- Periodicals; Face -- Abnormalities -- Surgery -- Periodicals; Fente palatine -- Périodiques; Crâne -- Malformations -- Périodiques; Manipulation crânienne -- Périodiques; Crâne -- Malformations -- Chirurgie -- Périodiques; Face -- Malformations -- Chirurgie -- Périodiques; Cleft palate; Cranial manipulation; Face -- Abnormalities -- Surgery; Skull -- Abnormalities; Skull -- Abnormalities -- Surgery; Cleft Lip; Cleft Palate; Facial Bones -- abnormalities; Skull -- abnormalities; Periodicals; Periodicals; Periodicals; 617.522
• DOI: 10.1177/1055665619857651
• Languages: English
• ISSNs: 1055-6656

Abstract

Objective: The gold standard for diagnosis of craniosynostosis is a clinical examination and motionless head computed tomography (CT). Computed tomography sedation is associated with increased cost, resource utilization, medical, and possible developmental risks. This study investigates whether a "feed and swaddle" protocol can be used to achieve diagnostic quality craniofacial imaging without the use of infant sedation. Design: Prospective cohort study. Setting: Tertiary academic medical center. Patients: Ninety patients <18 months of age undergoing evaluation for craniosynostosis from 2012 to 2018. Interventions: A feed and swaddle protocol. Main Outcome Measures: Diagnostic level imaging without the use of infant sedation. Results: Eighty-five (94%) achieved a diagnostic quality craniofacial CT scan using the "feed and swaddle" method. Mean patient age was 24.0 ± 10.0 weeks. Craniosynostosis was diagnosed in 74% of patients. Mean age of patients with successful completion of a CT scan was 23.7 ± 9.6 weeks, compared to 27.2 ± 17.1 weeks for unsuccessful completion. Mean weight for the successful group was 15.6 ± 2.9 pounds and 15.9 ± 2.5 pounds for the unsuccessful group. Mean travel distance was 59.2 ± 66.5 miles for successful patients and 66.5 ± 61.5 miles for unsuccessful patients. For the unsuccessful patients, there were no delays in surgical planning or scheduling. Conclusion: The "feed and swaddle" protocol described here is an effective alternative to infant sedation for motionless craniofacial CT imaging.