title: Defining Optimal Head-Tilt Position of Resuscitation in Neonates and Young Infants Using Magnetic Resonance Imaging Data.
abstract: Head-tilt maneuver assists with achieving airway patency during resuscitation. However, the relationship between angle of head-tilt and airway patency has not been defined. Our objective was to define an optimal head-tilt position for airway patency in neonates (age: 0-28 days) and young infants (age: 29 days-4 months). We performed a retrospective study of head and neck magnetic resonance imaging (MRI) of neonates and infants to define the angle of head-tilt for airway patency. We excluded those with an artificial airway or an airway malformation. We defined head-tilt angle a priori as the angle between occipito-ophisthion line and ophisthion-C7 spinous process line on the sagittal MR images. We evaluated medical records for Hypoxic Ischemic Encephalopathy (HIE) and exposure to sedation during MRI. We analyzed MRI of head and neck regions of 63 children (53 neonates and 10 young infants). Of these 63 children, 17 had evidence of airway obstruction and 46 had a patent airway on MRI. Also, 16/63 had underlying HIE and 47/63 newborn infants had exposure to sedative medications during MRI. In spontaneously breathing and neurologically depressed newborn infants, the head-tilt angle (median ± SD) associated with patent airway (125.3° ± 11.9°) was significantly different from that of blocked airway (108.2° ± 17.1°) (Mann Whitney U-test, p = 0.0045). The logistic regression analysis showed that the proportion of patent airways progressively increased with an increasing head-tilt angle, with > 95% probability of a patent airway at head-tilt angle 144-150°.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Utpal S
authors.initials: US
authors.lastname: Bhalala
authors.affiliation: Center for Biomedical Innovations and Design, Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Malvi
authors.initials: M
authors.lastname: Hemani
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Meehir
authors.initials: M
authors.lastname: Shah
authors.affiliation: Center for Biomedical Innovations and Design, Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Barbara
authors.initials: B
authors.lastname: Kim
authors.affiliation: Center for Biomedical Innovations and Design, Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Brian
authors.initials: B
authors.lastname: Gu
authors.affiliation: Center for Biomedical Innovations and Design, Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Angelo
authors.initials: A
authors.lastname: Cruz
authors.affiliation: Center for Biomedical Innovations and Design, Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Priya
authors.initials: P
authors.lastname: Arunachalam
authors.affiliation: Center for Biomedical Innovations and Design, Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Elli
authors.initials: E
authors.lastname: Tian
authors.affiliation: Center for Biomedical Innovations and Design, Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Christine
authors.initials: C
authors.lastname: Yu
authors.affiliation: Center for Biomedical Innovations and Design, Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Joshua
authors.initials: J
authors.lastname: Punnoose
authors.affiliation: Center for Biomedical Innovations and Design, Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Steven
authors.initials: S
authors.lastname: Chen
authors.affiliation: Center for Biomedical Innovations and Design, Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Christopher
authors.initials: C
authors.lastname: Petrillo
authors.affiliation: Center for Biomedical Innovations and Design, Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Alisa
authors.initials: A
authors.lastname: Brown
authors.affiliation: Center for Biomedical Innovations and Design, Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Karina
authors.initials: K
authors.lastname: Munoz
authors.affiliation: Center for Biomedical Innovations and Design, Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Grant
authors.initials: G
authors.lastname: Kitchen
authors.affiliation: Center for Biomedical Innovations and Design, Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Taylor
authors.initials: T
authors.lastname: Lam
authors.affiliation: Division of Pediatric Radiology and Pediatric Neuroradiology, Department of Radiology and Radiological Science, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Thangamadhan
authors.initials: T
authors.lastname: Bosemani
authors.affiliation: Division of Pediatric Radiology and Pediatric Neuroradiology, Department of Radiology and Radiological Science, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Thierry A G M
authors.initials: TA
authors.lastname: Huisman
authors.affiliation: Center for Biomedical Innovations and Design, Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Allen
authors.affiliation: Center for Biomedical Innovations and Design, Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Soumyadipta
authors.initials: S
authors.lastname: Acharya
mesh_terms: D000402:Airway Obstruction / Q000503:physiopathology*; D006257:Head / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008021:Life Support Systems; D008279:Magnetic Resonance Imaging; D011187:Posture / Q000502:physiology*; D012151:Resuscitation; D012189:Retrospective Studies