BACKGROUND The survival of very low birth weight (VLBW) infants increased in the past few decades. These neonates often require multiple diagnostic and management image procedures that involve ionizing radiation, which can have long term implications. The aim of our study was to evaluate the level of radiation exposure in VLBW infants during their stay in the Neonatal Intensive Care Unit (NICU). METHODS We collected demographic and medical data of 149 VLBW who were admitted to our NICU between January 2011 and December 2014. All radiographic procedures were reviewed retrospectively. Absorbed ionizing radiation was calculated according to literature reference values. RESULTS A total of 1496 images were obtained. Infants underwent 10.0±11.3 examinations, and the maximum of images registered per patient was 65. Four babies (2.7%) received more than 1000 µSv, the recommended maximum of ionizing radiation exposure. Infants of lower birth weight, who needed invasive ventilation, with bronchopulmonary dysplasia, sepsis, and surgical pathology required significantly more radiographs (P<0.001). CONCLUSIONS In this study, lower birth weight, need of invasive ventilation, bronchopulmonary dysplasia and sepsis were associated with the need of more X-ray studies. In order to protect the vulnerable population of severely-ill newborns, guidelines for radiation exposure in newborns should be issued and implemented.