X-ray and CMV exposure in NICU during pregnancy?

prmenrs, RN · Aug 17, 2005

We actually had some nurses wearing the exposure badges for awhile several years ago to see what our exposure was. Turned to be practically nothing. The machines should be coned down to the absolute minimum exposure necessary for the exam. You don't want the babies receiving that much radiation either. Even w/that knowledge, pregnant nurses opted out of X-rays, and others would assist w/the X-Rays. There were never any problems--we all figured it might be our turn someday.

As long as universal precautions are followed, you shouldn't be that worried about CMV--don't forget there might be an undiagnosed baby out there somewhere, too. Again, our pregnant nurses could refuse that assignment, if they wanted.

Gompers, BSN, RN · Aug 17, 2005

As for the radiation, I wouldn't worry too much. Like prmenrs said, there really is very little radiation involved in the X-rays we do on neonates. The "scatter radiation" that occurs out side of the actual X-ray (the area that lights up when they're setting their borders) is next to nothing. So even being at the bedside of a baby getting X-rayed, you would be okay. A few feet away, and it's probably immeasurable. My dad works in radiology, and for years worked as a tech doing bedside X-rays - never once wore a lead gown and was always within a few feet of the bed - and he never had any radiation show up on his lapel badge. This was 20-30 years ago, too, and since then it's gotten even safer.

The one thing we do need to worry about is when we do cross-table or left lateral X-rays - then they are shooting the X-ray AT you as you hold it up in front of the baby. Again, the "scatter radiation" that you're exposed to is next to nothing, but just make sure and cover your neck with the lead apron - your thyroid is super sensitive to radiation and there is an increase in thyroid cancer with healthcare professionals.

As far as getting pregnant and staying pregnant on nights, I suppose it really has more to do with how well you tolerate your schedule than anything else. I've seen nurses who hate working nights, always have trouble sleeping, etc. - and yeah, they have more trouble concieving - probably due to increased emotional and physical stress. Others (like me) who are born night owls, they don't seem to have any problems with pregnancy.

As far as the CMV is concerned, yeah, you never know when you might be exposed to such a patient. Best bet is to make sure to always wear gloves when you are dealing with ANY baby. Some people tell their managers right away when they concieve, others choose to wait a few months. We do have babies with suspected CMV, herpes, etc. and they have "no pregnant RNs" written on the charge nurse's chart. So it's really up to you and your own superstitions, I suppose.

Good luck!

sparkyRN · Aug 17, 2005

Worked nights, rotated shifts, been sleep deprived...still managed to have 4 normal pregnancies over the course of 8 years. My advice to you is to keep up your precautions because it will decrease your anxiety about all the "what-ifs" you might face. When you do get pregnant, let your NM and charge nurse know so you can avoid the TORCH babies if at all possible. You may be extra tired, so rest when you can.

Sparky

babynurselsa, RN · Aug 17, 2005

X-ray exposure if you do the normal precautions shouldn't be a problem. I would avoid holding the plate for a cross table or L lat decub shot.

Also just stand a few feet away. This is low level radiation to shoot through and infant, not like the level needed to shoot through a 500lb pt and even then they just say you need to be 6 ft away and not in the path of the beam

CMV is excreted in the urine of CMV + infants. Utilizing unversal precautions and wearing gloves is sufficent protection, though everyplace that I worked we always gowned and gloved for r/o CMV babies. Obviously, if you have a known r/o or actual CMV + kiddo avoid that assignment. It is the unknowns that you need to always practice good precautions for.

The references that I looked up with my 3rd daughter stated daycare providers were at higher risk than NICU nurses for the CMV exposure.

CapeMaui · Aug 18, 2005

Thank you everyone!! Your responses have put my mind more at ease! I was so worried about all the xrays going on around me, and with the CMV, I always glove to change diapers, so I feel better about that. With our babies that are r/o or CMV/Torch+, we always gown and glove too, I guess it is just in case the urine leaked through diaper and gets on the clothes....

As for pregnancy, thanks for all the tips/advice. I keep hearing scary stories about how so and so couldn't get preg b/c she worked nights.... hopefully that won't be me. I wil definitely rest as much as I can when I do get preg. I'm just not sure how soon to tell the NM, etc to avoid CMV/Torch assignments. Since I've only been here 5 mons, I don't want that to be perceived badly.... Then again, who's to say that I'll get it on the first try on nights

Thanks again, if anyone thinks of anything else, PLEASE SHARE :)

BittyBabyGrower, MSN, RN · Aug 18, 2005

Just make sure you tell the tech that there is a preggie in the room...ours are very good though. And don't worry about nights being bad for getting PG...when I was pregnant, me and my friends all worked nights and we started delivering babies in July and didn't stop until the next March :chuckle I think it made us more fertile :rotfl:

CapeMaui · Aug 23, 2005

So, apparently, > 80% of healthy adults are already CMV IgG antibody (+), does anyone know what this means to people who are looking to get pregnant? Does this affect the fetus the same way an actual exposure to CMV does? I mean, I know that + for CMV IgG antibody just mean that the person has been exposed to CMV at some point in their lives, IgM must be tested and a culture will probably be needed to see if there's an active infection going on... But what is the risk to the fetus??

prmenrs, RN · Aug 23, 2005

I think it has to be a new infection to affect the fetus.

CapeMaui · Aug 23, 2005

What if the person has an active infection going on? CDC site says that as long as the infection was more than 6 months before preg, the fetus would be safe.... however, what if the person still has an active infection (primary or not)?

I'm sure most nurses working in the NICU or working with children in general are of the 80% with + CMV IgG antibody... there's no way of knowing if there's an active infection since it's asymptomatic in healthy adults... will it affect the fetus when the woman becomes preggo?

Gompers, BSN, RN · Aug 23, 2005

I don't know about your areas, but in my neck of the woods, we barely see babies sick from CMV. I can only remember two in the seven years I've worked NICU.

We only test for it in really sick babies, and none have ever come back positive. The two I'm thinking of came in very sick and had the telltale blueberry muffin looking spots on them already.

Two. In seven years.

CapeMaui · Aug 23, 2005

Gompers, You're right, I'm sorry, that was a dumb assumption on my part... I work in a big city hospital and we do see a lot of babies born to Moms who used drugs or live in shelters, etc. I've only had 2 babies with CMV+ and a couple with r/o CMV, but other nurses have told me that they have had quite a few. That's why I thought prob most nurses in the city hospitals would have had exposure and therefore + for the antibody...

Apparently, it's more prevalent in day care health workers than in the hospital, as we are more consciencious of universal precaution. I'm just wondering what would be the effects on the fetus should the woman get preggo while having an active infection, primary or not...