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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Special Article

Choosing Wisely in Newborn Medicine: Five Opportunities to Increase Value

Timmy Ho, Dmitry Dukhovny, John A.F. Zupancic, Don A. Goldmann, Jeffrey D. Horbar and DeWayne M. Pursley
Pediatrics July 2015, peds.2015-0737; DOI: https://doi.org/10.1542/peds.2015-0737
Timmy Ho
aDepartment of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts;
bDepartment of Medicine, Boston Children’s Hospital, Boston, Massachusetts;
cInstitute for Healthcare Improvement, Cambridge, Massachusetts;
dDepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts;
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Dmitry Dukhovny
aDepartment of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts;
eDepartment of Pediatrics, Oregon Health and Science University, Portland, Oregon;
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John A.F. Zupancic
aDepartment of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts;
bDepartment of Medicine, Boston Children’s Hospital, Boston, Massachusetts;
dDepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts;
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Don A. Goldmann
bDepartment of Medicine, Boston Children’s Hospital, Boston, Massachusetts;
cInstitute for Healthcare Improvement, Cambridge, Massachusetts;
dDepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts;
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Jeffrey D. Horbar
fDepartment of Pediatrics, University of Vermont, Burlington, Vermont; and
gVermont Oxford Network, Burlington, Vermont
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DeWayne M. Pursley
aDepartment of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts;
bDepartment of Medicine, Boston Children’s Hospital, Boston, Massachusetts;
dDepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts;
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Abstract

BACKGROUND: The use of unnecessary tests and treatments contributes to health care waste. The “Choosing Wisely” campaign charges medical societies with identifying such items. This report describes the identification of 5 tests and treatments in newborn medicine.

METHODS: A national survey identified candidate tests and treatments. An expert panel of 51 individuals representing 28 perinatal care organizations narrowed the list over 3 rounds of a modified Delphi process. In the final round, the panel was provided with Grading of Recommendation, Assessment, Development and Evaluation (GRADE) literature summaries of the top 12 tests and treatments.

RESULTS: A total of 1648 candidate tests and 1222 treatments were suggested by 1047 survey respondents. After 3 Delphi rounds, the expert panel achieved consensus on the following top 5 items: (1) avoid routine use of antireflux medications for treatment of symptomatic gastroesophageal reflux disease or for treatment of apnea and desaturation in preterm infants, (2) avoid routine continuation of antibiotic therapy beyond 48 hours for initially asymptomatic infants without evidence of bacterial infection, (3) avoid routine use of pneumograms for predischarge assessment of ongoing and/or prolonged apnea of prematurity, (4) avoid routine daily chest radiographs without an indication for intubated infants, and (5) avoid routine screening term-equivalent or discharge brain MRIs in preterm infants.

CONCLUSIONS: The Choosing Wisely Top Five for newborn medicine highlights tests and treatments that cannot be adequately justified on the basis of efficacy, safety, or cost. This list serves as a starting point for quality improvement efforts to optimize both clinical outcomes and resource utilization in newborn care.

  • Accepted April 28, 2015.
  • Copyright © 2015 by the American Academy of Pediatrics

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Pediatrics
Vol. 147, Issue 4
1 Apr 2021
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Choosing Wisely in Newborn Medicine: Five Opportunities to Increase Value
Timmy Ho, Dmitry Dukhovny, John A.F. Zupancic, Don A. Goldmann, Jeffrey D. Horbar, DeWayne M. Pursley
Pediatrics Jul 2015, peds.2015-0737; DOI: 10.1542/peds.2015-0737

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Choosing Wisely in Newborn Medicine: Five Opportunities to Increase Value
Timmy Ho, Dmitry Dukhovny, John A.F. Zupancic, Don A. Goldmann, Jeffrey D. Horbar, DeWayne M. Pursley
Pediatrics Jul 2015, peds.2015-0737; DOI: 10.1542/peds.2015-0737
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  • Reduction in Unintended Extubations in a Level IV Neonatal Intensive Care Unit
  • Adherence of Newborn-Specific Antibiotic Stewardship Programs to CDC Recommendations
  • Variation in Use by NICU Types in the United States
  • Diagnosis and Management of Gastroesophageal Reflux in Preterm Infants
  • A Quality Improvement Project to Improve Evidence-Based Inhaled Nitric Oxide Use
  • Imaging the neonatal brain in the 21st century: why, when and how?
  • Implementation of a Guideline to Decrease Use of Acid-Suppressing Medications in the NICU
  • Engaging patients and the public in Choosing Wisely
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  • Incidental findings on routine brain MRI scans in preterm infants
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