ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Neonatology
Volume 13 - 2025 | doi: 10.3389/fped.2025.1642629
This article is part of the Research TopicPOCUS for Neonates: Advancing Care with Point-of-Care UltrasoundView all 6 articles
Neurodevelopmental Impact of Early Diagnostic Imaging in Preterm Infants: Quantifying Risk and the Role of Point-of-Care Ultrasound (POCUS)
Provisionally accepted
- 1Tufts Medical Center, Boston, United States
- 2Tufts University School of Medicine, Boston, United States
- 3George Mason University, Fairfax, United States
- 4Harvard Medical School, Boston, United States
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Medical imaging is essential in neonatal intensive care units (NICUs), particularly for the management of preterm infants. However, concerns persist regarding the neurodevelopmental impact of repeated low-dose radiation exposure. This study aimed to investigate whether cumulative X-ray exposure in the first month of life is associated with neurodevelopmental outcomes in preterm infants.We conducted a retrospective chart review of preterm infants (<34 weeks gestation) admitted to the Level IIIB NICU at Tufts Medical Center. Infants were included if they had at least one X-ray within the first 24 hours of life and were followed consistently at the neurodevelopmental clinic till 12 to 18 months corrected age. Exclusion criteria included major congenital anomalies, severe perinatal complications and loss to follow-up. Cumulative X-ray exposure was recorded at Day 1, Day 7, and Month 1. Neurodevelopment was assessed using Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Multiple linear regression analyses were used to assess associations, adjusting for gestational age, birth weight, comorbidities and SNAPPE-II scores.Among 53 infants, cumulative imaging by Day 7 and Month 1 was significantly associated with lower Bayley-III motor and cognitive scores. Each additional X-ray by Day 7 was associated with a 1.38-point decline in motor scores (p < 0.001) and a 0.89-point decline in cognitive scores (p = 0.046). These associations persisted at Month 1. No significant effects were found for imaging on Day 1. Language outcomes showed non-significant downward trends.Frequent X-ray exposure in the first month of life may be associated with worse motor and cognitive development in preterm infants. These findings suggest the need for weight-based diagnostic reference levels in NICUs and support incorporation of alternative imaging such as point of care ultrasound (POCUS into routine neonatal intensive care.
Keywords: preterm infants, neurodevelopment, NICu, X-ray exposure, Bayley-III, SNAPPE-II, neonatal imaging, Cumulative radiation
Received: 06 Jun 2025; Accepted: 31 Jul 2025.
Copyright: © 2025 Bhattacharjee, Volpe, Bhattacharjee, Sibley and Church. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Indrani Bhattacharjee, Tufts Medical Center, Boston, United States
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