OBJECTIVES. The safety of nonionic contrast agents with that of ionic iodinated contrast agents in children is compared.
METHODS. A comprehensive literature search was conducted to identify all publications on the safety profile of nonionic contrast agents administered intravenously to children. This information was compared to published data on the safety of nonionic media in adults and on the safety of ionic agents in children.
RESULTS. There appears to be strong evidence for increased safety of nonionic agents in children compared with ionic agents, although the published data reviewed are subject to methodological criticism. Moderately severe and minor reactions occur less frequently with nonionic agents. Deaths occur too infrequently to permit a valid evaluation. Contrary to previous beliefs, the incidence of adverse reactions in children appears to be similar to the incidence in adults.
CONCLUSIONS. Although nonionic agents offer improved safety, it is still not clear whether this benefit justifies the associated costs, because conventional ionic agents are already extremely safe. However, it may be possible to justify the increased cost of nonionic agents in children based solely on the reduction of minor reactions. Data regarding the safety of nonionic agents in children are limited, and large, prospective studies are warranted.