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Our estimates of neonatal radiation exposure fall short of reality

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Abstract

The purpose of this study is to evaluate radiation exposure in newborns undergoing imaging tests during the first 30 days of neonatal intensive care unit (NICU) hospitalization. A retrospective cohort study was conducted from November 2018 to April 2019 with newborns admitted to the NICU. Thermoluminescent dosimeters (TLD-100™) measured radiation emitted during imaging exams over 1 month, with a comparison between measured and estimated radiation. The cohort exhibited a median gestational age of 33.0 (31.0, 37.0) weeks, a median birth weight of 1840 (1272, 2748) g, and a median length of stay of 25.5 (11.7, 55.0) days. Eighty-four patients underwent 314 imaging tests, with an estimated radiation dose (ERD) per patient of 0.116 mSv and a measured radiation dose (MDR) of 0.158 mSv. ERD consistently underestimated MDR, with a mean difference of −0.043 mSv (−0.049 to −0.036) in the Bland-Altman analysis. The regression equation was as follows: difference MRD – ERD = −1.7 × (mean (MRD + ERD)) + 0.056. The mean estimated radiation dose per exam was 0.030 mSv, and the chest X-rays accounted for 63.26% of total exams. The median number of radiographic incidences per patient was 2 (1, 4), with 5 patients undergoing three or more exams in a single day.

Conclusion: Radiation exposure in these newborns was underestimated, emphasizing the need for awareness regarding associated risks and strict criteria for requesting radiological exams. Lung ultrasound is a radiation-free and effective option in managing respiratory diseases in newborns, reducing the reliance on chest X-rays.

What is Known:

• Radiation used in diagnostic exams is not risk-free.

• Radiation risk is much higher in small Infants due to the exposure area and the prolonged expectance of life.

What is New:

• Radiation exposure is underestimated in the neonatal population.

• The study found a mean radiation exposure in neonates about 5% of the mean annual dose in the general population.

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Data availability

The data that supports the findings of this study are available on request from the corresponding author.

Abbreviations

NICU:

Neonatal intensive care unit

IQR:

Interquartile range

ERD:

Estimated radiation dose

MDR:

Dose measured by the dosimeter

ERD-MDR:

The mean difference between the MDR and the ERD

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil

    Michelle Toscan, Breno Fauth de Araújo & Vandréa Carla de Souza

  2. Hospital Geral de Caxias do Sul, Caxias do Sul, Brazil

    Michelle Toscan, Breno Fauth de Araújo & Vandréa Carla de Souza

  3. Programa de Pós Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Michelle Toscan

  4. Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil

    Júlio César Martini & Rafaela Ravazio

  5. Programa de Pós Graduação em Ciências da Computação, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil

    Rafaela Ravazio

  6. Programa de Pós Graduação em Ciências da Saúde, Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil

    Vandréa Carla de Souza

Authors
  1. Michelle Toscan
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  2. Breno Fauth de Araújo
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  3. Júlio César Martini
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  4. Rafaela Ravazio
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  5. Vandréa Carla de Souza
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Contributions

All authors contributed to the study conception and design. JCM and RR organized the data collection; VCS and BFA analyzed the data; MT drafted the manuscript; VCS contributed to drafting the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Michelle Toscan.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Comitê de Ética em Pesquisa da Universidade de Caxias do Sul (Rua Francisco Getúlio Vargas, n° 1130, Petrópolis, Campus-sede, Bloco S, sala 405, cep-ucs@ucs.br) em 31/05/2023, n° 68164823.3.0000.5341.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Daniele De Luca

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Toscan, M., de Araújo, B.F., Martini, J.C. et al. Our estimates of neonatal radiation exposure fall short of reality. Eur J Pediatr 183, 1911–1916 (2024). https://doi.org/10.1007/s00431-024-05466-x

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