Cummulative radiation exposure during premature infants neonatal intensive care unit stay (C-RED-PINS)

Abstract

Background: During pregnancy, x-ray exposure to the maternal-fetal unit is avoided unless absolutely necessary. Viable premature infants survive because of the technology of modern Neonatal Intensive Care Units (NICU), but are exposed to many x-rays. We reviewed the x-ray exposure to those infants in our NICU, quantifying the number of x-rays taken for placement of central venous lines (CVL), respiratory illnesses, and gastrointestinal illnesses (GI). Design Methods: 5-yr retrospective analysis of premature infants less than 33 weeks gestation who received CVL placement during their NICU stay. The study was reviewed by the Institutional Review Board and classified as exempt. X-rays were categorized by indication. X-rays for CVL placement were counted separately. Gl indications included: necrotizing enterocolitis evaluation, bilious aspirates, and other Gl symptoms. Respiratory indications included: diagnosis of respiratory distress syndrome, endotracheal tube placement, and respiratory deterioration. Results: There were 216 infants 29.2±2.3 (mean± SO) weeks gestation, 1262±441 g birth weight. An average of 15.0±15.0 x-rays were taken per infant of which 4.4±2.9 were taken for CVL placement, 5.7±9.9 for Gl indications, and 5.2±9.3 for respiratory indications. These infants had 2.2±1.2 CVL's placed per patient (93% of patients had an umbilical venous catheter and 69% a PICC line). There were 4.5±4.3 babygrams (including gonadal exposure for all females and many males) per patient, 2.8±2.0 babygrams/patient were taken for CVL placement. Conclusions: More research is needed to quantify and reduce the x-ray exposure to vulnerable premature infants, and to assess the long-term effects of this level of radiation exposure. Bedside ultrasounds and other strategies should be considered as ways to reduce the number of x-rays that are taken in NICU patients.