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

Abdullah Alshehri1, Rayan Hejles2, Mohammad Aldaffaa3

  • 1Pediatric Surgery, King Saud University, Riyadh, SAU.

Cureus
|December 29, 2025
PubMed

Insights

Gastrointestinal contrast imaging is safe for infants and does not increase necrotizing enterocolitis (NEC) risk. Avoid hyperosmolar agents in active NEC cases.

Area of Science:

  • Pediatric Radiology
  • Neonatal Gastroenterology
  • Clinical Safety Studies

Background:

  • Gastrointestinal (GI) contrast imaging is a common diagnostic tool for pediatric patients.
  • Concerns exist regarding potential adverse effects of contrast agents on the infant intestinal wall, especially in premature infants or those with inflammation.
  • These concerns are largely based on anecdotal evidence and older animal research.

Purpose of the Study:

  • To evaluate the association between GI contrast agent exposure and the incidence of necrotizing enterocolitis (NEC) within 30 days in infants.
  • To address clinical uncertainties regarding the safety of GI contrast agents in vulnerable infant populations.

Main Methods:

  • Retrospective study at a single tertiary care institution with a Level IV NICU.
  • Included 245 infants who underwent GI contrast-enhanced radiological studies.
  • Primary outcome: development of NEC within 30 days post-contrast exposure.

Main Results:

  • Out of 245 infants, 15 (6.1%) had a prior NEC diagnosis over two weeks before imaging.
  • One term newborn with suspected NEC experienced intestinal perforation after contrast exposure.
  • No increased incidence of NEC was observed within 30 days of contrast agent administration.

Conclusions:

  • GI contrast agent exposure appears safe for infants, including premature newborns, without elevating NEC risk within 30 days.
  • Caution is advised, suggesting avoidance of hyperosmolar contrast agents in infants with active NEC.
  • Further research may refine safety protocols for contrast use in neonatal GI imaging.
Abstract

Keywords:
bariumcontrast mediumfluoroscopyinfantsnecrotizing enterocolitis

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