The use of low osmolality water soluble (LOWS) contrast media in the pediatric gastro-intestinal tract

Abstract

There are dangers in the use of either barium sulphate suspensions or the conventional hypertonic water soluble contrast media in the gastrointestinal tract of "at risk" babies and children. These dangers can be avoided by the use of low osmolality water soluble (LOWS) contrast media. This paper reports the satisfactory use of three such contrast media, ioxaglate (Hexabrix), iohexol (Omnipaque) and iopamidol (Niopam) in 115 examinations of the gastrointestinal tracts of 89 babies and children. Morbidity from the inhalation or extravasation of contrast medium was negligible. It is proposed that LOWS contrast media should be used more widely in the gastro-intestinal investigation of all "at risk" babies and children.

Incidence of septicemia immediately after elective gastrointestinal contrast procedures in infants: a cohort study

“…In this study, a wide range of protocols and contrast media were used in infants who developed sepsis, including barium, highosmolarity, and low-osmolarity water-soluble media. This variety of conditions make it difficult to infer any causal relationships between methods used and risk of complications, although some authors have advocated for the preferential use of low-osmolarity contrast media in neonates and higher risk infants [2,14,15]. With regard to the use of antibiotic prophylaxis, there is no consensus as to who should be treated, largely because of a lack of prevalence data and supporting evidence for benefits from this intervention [13].…”

“…Those are the premature neonates who should be considered at higher risk and in whom preventive measures would be likely most beneficial to avoid serious morbid or even lethal consequences of contrast procedure-associated sepsis. Hypertonic contrast media have been associated with higher risk of complications in neonates [14]. In this study, a wide range of protocols and contrast media were used in infants who developed sepsis, including barium, highosmolarity, and low-osmolarity water-soluble media.…”

Polysorbate 80 and Low-Osmolality Water-Soluble Contrast Medium Enema in Diagnosis and Treatment of Faecal Obstruction in Malignant Phaeochromocytoma

“…The potential for hyperosmolar solutions to de stabilise an already critical salt and water balance is known (4). An alternative using a low-osmolar watersoluble contrast medium with 1% Tween 80 has been advocated to avoid the dangers of intra-enteric hyperosmolar solutions (13). The stimulatory effect of Gastrografin on peristalsis may be helpful in the treatment of the patient with small bowel obstruction such as meconium ileus or equivalent but is contraindicated in large bowel obstruction.…”

The use of non-ionic water-soluble contrast agents for small bowel follow-through examination

“…Presumably therapeutic effect is related to hypertonicity, but this also reduces distal contrast and may cause dehydration, especially in children. To counter this, in 1986 Ratcliffe proposed non-ionic agents for small bowel examination in children [6], with other authors soon advocating a role in adults [7]. Direct comparisons between ionic and nonionic agents have been made [8], with cited advantages of improved distal contrast and non-toxicity within the peritoneal cavity.…”