Survey of Acoustic Output in Neonatal Brain Protocols

BACKGROUND

Auditory and non-auditory safety concerns associated with the appreciable sound levels inherent to magnetic resonance imaging (MRI) procedures exist for neonates. However, current gaps in knowledge preclude making an adequate risk assessment.

PURPOSE

To measure acoustic exposure (duration, intensity, and frequency) during neonatal brain MRI and compare these values to existing hearing safety limits and data.

STUDY TYPE

Phantom.

PHANTOM

Cylindrical doped water phantom.

FIELD STRENGTH/SEQUENCE

Neonatal brain protocols acquired at 1-3 T. Scans in the model protocol included a diffusion tensor imaging scan, a gradient echo, a three-dimensional (3D) fast spin echo, 3D fast spin-echo single-shots, a spin echo, a turbo spin echo, a 3D arterial spin labeling scan, and a susceptibility-weighted fast spin-echo scan.

ASSESSMENT

The sound pressure levels (SPLs), frequency profile, and durations of five neonatal brain protocols on five MR scanners (scanner A [3 T, whole-body], scanner B [1.5 T, whole-body], scanner C [1 T, dedicated neonatal], scanner D [1.5 T, whole-body], and scanner E [3 T, whole-body]) located at three different sites were recorded. The SPLs were then compared to the International Electrotechnical Commission (IEC) hearing safety limit and existing data of infant non-auditory responses to loud sounds to assess risk.

STATISTICAL TESTS

Mann-Whitney U test to assess whether the dedicated neonatal scanner was quieter than the other machines.

RESULTS

The average level A-weighted equivalent value (LAEQ) across all five MR scanners and scans was 92.88 dBA and the range of LAEQs across all five MR scanners and scans was 80.8-105.31 dBA. The duration of the recorded neonatal protocols maintained by neonatal scanning facilities (from scanners A, B, and C) ranged from 27:33 to 37:06 minutes.

DATA CONCLUSION

Neonatal protocol sound levels straddled existing notions of risk, exceeding sound levels known to cause non-auditory responses in neonates but not exceeding the IEC MRI SPL safety limit.

LEVEL OF EVIDENCE

5 TECHNICAL EFFICACY: Stage 5.

Pediatric Pharmacy Services in Canadian Adult Hospitals: An Inventory and Prioritization of Services

BACKGROUND

The rate of potential adverse drug events is reported to be 3 times higher among pediatric inpatients than among their adult counterparts. Various methods have been suggested to reduce medication errors in pediatric patients. One of the most influential of these strategies is inclusion of a clinical pharmacist on the multidisciplinary care team. However, there is currently no literature describing the inventory of pharmacy services provided to pediatric patients in Canadian adult hospitals.

OBJECTIVES

The primary objective of this study was to describe pediatric and neonatal pharmacy services provided in adult hospitals in Canada. The secondary objective was to determine whether the services provided correspond to services that pharmacists working in Canadian pediatric hospitals identified as important for adult hospitals that provide pediatric services.

METHODS

Two web-based surveys were created, focusing on 35 pharmacy services. The first survey was intended for adult hospitals, and the second for pediatric hospitals. The surveys were distributed by e-mail and were completed in January and February 2018.

RESULTS

A total of 55 and 43 valid responses were received from respondents in adult hospitals and pediatric hospitals, respectively. An inventory of pharmacy services provided by adult hospitals to their pediatric and neonatal patients was obtained. Of the adult hospitals that responded, 61% (33/54) had pharmacists assigned to pediatric or neonatal units. The frequency with which most pharmacy services were provided was comparable to the importance identified by pharmacists working in pediatric hospitals. However, for the provision of education during admission and at discharge and for the provision of medication reconciliation at discharge, frequency and importance were not comparable.

CONCLUSIONS

Adult hospitals with a pharmacist assigned to an inpatient pediatric or neonatal clinical area met most expectations of pharmacists working in pediatric hospitals in terms of pharmacy services provided. However, some services require optimization for this patient population.