Effectiveness of Chloral Hydrate on Brain MRI in Children with Developmental Delay/Intellectual Disability Comparing with Normal Intelligence: Single Tertiary Center Experience.

Ja Un Moon,Ji Yoon Han

doi:10.3390/children8121097

Abstract

Neurodiagnostic investigation requirements are expanding for diagnostic and therapeutic purposes in children, especially in those with developmental delay/intellectual disability (DD/ID). Thus, determination of optimal sedatives to achieve successful sedation and immobility without further neurological compromise is important in children with DD/ID. The purpose of this study is to assess the effectiveness and adverse reactions of chloral hydrate (CH) for brain magnetic resonance imaging (B-MRI) in children with DD/ID compared to those with normal intelligence (NI). We performed a retrospective chart review of children aged from 1 day to 12 years who required elective sedation using CH for B-MRI. About 730 cases (415 with DD/ID and 315 with NI) of CH sedation were conducted for B-MRI. Children with DD/ID showed a higher failure rate (22%) than did those with NI (6%); additional CH and prolonged sedation time were required. There was no difference in incidence of adverse reactions between DD/ID and NI groups (p = 0.338). Older or heavier children with DD/ID (p = 0.036 and p = 0.013, respectively), as well as those diagnosed with epilepsy or neuropsychiatric disorders showed higher risk of sedation failure (p < 0.001 for each). In conclusion, CH was a suboptimal sedative drug for children with DD/ID compared with those with NI. Other alternative or supplementary sedatives should be taken into consideration especially for those vulnerable groups.

Highlights

Developmental delay/intellectual disability (DD/ID) are common problems that affect between 1 and 3% of all pediatric populations [1]
Chloral hydrate (CH) is recommended for painless procedures in pediatric patients who have difficulty cooperating with neurodiagnostic investigations [3,4], but only a small number of studies has reported its use in pediatric patients with DD/ID
We retrospectively reviewed the medical charts of pediatric patients who required sedation for brain magnetic resonance imaging (B-MRI) in the outpatient clinic

Summary

Introduction

Developmental delay/intellectual disability (DD/ID) are common problems that affect between 1 and 3% of all pediatric populations [1]. Neurodiagnostic investigations (e.g., brain magnetic resonance imaging (B-MRI), electroencephalography (EEG), and auditory brainstem response (ABR)) have played an important role in finding etiologic causes, predicting prognosis, and providing optimal treatment of many neurologic diseases. To obtain accurate data from neurodiagnostic procedures, it is important for the child to maintain absolute immobility during prolonged procedures. Pediatric patients, those with DD/ID, frequently require sedatives to reduce motion artifacts, diminish anxiety, and successfully complete studies. The purpose of this study was to evaluate the effectiveness and adverse effects of CH sedation for B-MRI in children with DD/ID to make rational, effective, and safe choices without causing further neurological exacerbation in those children

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Discussion

Conclusion