In Reply.—In response to Dr Milstein's letter, I have the following comments.
Small premature infants in a neonatal intensive care unit may have to be reintubated frequently due to tube
displacement or tube blockage. In some of these instances extremely small infants had 30 to 40 roentgenographic studies during the hospital stay. A major proportion of them were for tube position and not only for monitoring changes in their clinical condition. Obviously, if these studies were eliminated, the cumulative dose of radiation would be reduced. If all these studies have so far not been proven to be detrimental, they have not been proven to be beneficial. Any dose of radiation that can be eliminated in premature infants should be eliminated, as small as it may be.
We have studied in cadavers the effect of esophageal intubation with the endotracheal tube guide. In infants under 600 g the light impression