OBJECTIVES: Preterm infants are exposed to frequent chest radiography. While required for clinical decision making, significant cumulative exposure to radiation could have long-term implications. We wish to investigate the association between mode of ventilation and number of chest radiographs performed during neonatal intensive care unit stay in infants with respiratory support.

METHODS: We conducted a retrospective cohort study using the 2019-2021 Premier Healthcare Database, a large all-payer service-level US-hospitals database. Liveborn infants of ≤36 weeks gestational age (GA) with respiratory support identified by ICD-10 PCS codes who had at least one chest radiograph were included in the analysis. Infants were stratified by GA and invasive mechanical ventilation only (IMV), non-invasive only (NIV), IMV then NIV and NIV then IMV.

RESULTS: Of the 17,843 infants who met the study criteria, 56% were born at 32-36weeks GA. Fifty-three percent were in the NIV only, 37% in IMV only and 11% had a switch of mode of ventilation. Infants born <25weeks had the highest number of chest radiation regardless of mode of ventilation. The highest exposure was found in the IMV then NIV group, <25weeks GA 37.7 (SD=23.2) vs. 17.1 (SD=15.2) in 25-27weeks, 8.3 (SD=8.4) in 28-31weeks, and 6.9 (SD=11.0) in 32-36weeks, P<0.0001, average cost ranging from $2,794 to $487. The lowest exposure was found in the in NIV only strata with average cost ranging from $157 to $879.

CONCLUSIONS: Infants born at the limits of viability have significant higher exposure to chest radiograph during their long hospital stay. The risk is accentuated by IMV and the switch of mode of ventilation. The long-term health impact of these exposure and the strategies to limit them need to be further investigated.