Evaluating the Safety of Gastrointestinal Contrast Agents in Pediatric Patients: A Retrospective Study.

BACKGROUND: Gastrointestinal (GI) contrast imaging is commonly performed in pediatric patients to diagnose and treat various GI conditions. However, a widely held clinical belief suggests that contrast agents may have deleterious side effects on the intestinal wall, particularly in premature infants or those with pre-existing intestinal inflammation. This presumed risk is primarily supported by anecdotal reports and older animal studies. OBJECTIVE: This study aimed to investigate the potential association between GI contrast agent exposure and the development of necrotizing enterocolitis (NEC) within a 30-day period in infants. MATERIALS AND METHODS: A retrospective study was conducted at a single tertiary care institution with a level IV neonatal intensive care unit. All 245 infants who underwent any form of GI contrast-enhanced radiological study were included. The primary outcome was the development of NEC within 30 days following exposure to a contrast agent. RESULTS: A total of 245 patients were included, of whom 15 (6.1%) had a documented history of NEC occurring more than two weeks prior to undergoing contrast imaging. Only one term newborn suspected of NEC progressed to intestinal perforation following contrast agent exposure. CONCLUSION: Our findings suggest that GI contrast agent exposure is generally safe in infants and does not increase the risk of NEC development within 30 days, including premature newborns. However, it may be safer to avoid hyperosmolar contrast agents in patients with active NEC.