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

Research output: Contribution to journalArticle

51 Citations (Scopus)

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 termequivalent 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.

Original languageEnglish (US)
Pages (from-to)e482-e489
JournalPediatrics
Volume136
Issue number2
DOIs
StatePublished - Aug 1 2015

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Medicine
Newborn Infant
Therapeutics
Apnea
Premature Infants
Perinatal Care
Medical Societies
Gastroesophageal Reflux
Quality Improvement
Bacterial Infections
Thorax
Organizations
Anti-Bacterial Agents
Delivery of Health Care
Safety
Costs and Cost Analysis
Brain
Surveys and Questionnaires

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

Cite this

Ho, T., Dukhovny, D., Zupancic, J. A. F., Goldmann, D. A., Horbar, J. D., & Pursley, D. M. (2015). Choosing wisely in newborn medicine: Five opportunities to increase value. Pediatrics, 136(2), e482-e489. https://doi.org/10.1542/peds.2015-0737

Choosing wisely in newborn medicine : Five opportunities to increase value. / Ho, Timmy; Dukhovny, Dmitry; Zupancic, John A F; Goldmann, Don A.; Horbar, Jeffrey D.; Pursley, Dewayne M.

In: Pediatrics, Vol. 136, No. 2, 01.08.2015, p. e482-e489.

Research output: Contribution to journalArticle

Ho, T, Dukhovny, D, Zupancic, JAF, Goldmann, DA, Horbar, JD & Pursley, DM 2015, 'Choosing wisely in newborn medicine: Five opportunities to increase value', Pediatrics, vol. 136, no. 2, pp. e482-e489. https://doi.org/10.1542/peds.2015-0737
Ho T, Dukhovny D, Zupancic JAF, Goldmann DA, Horbar JD, Pursley DM. Choosing wisely in newborn medicine: Five opportunities to increase value. Pediatrics. 2015 Aug 1;136(2):e482-e489. https://doi.org/10.1542/peds.2015-0737
Ho, Timmy ; Dukhovny, Dmitry ; Zupancic, John A F ; Goldmann, Don A. ; Horbar, Jeffrey D. ; Pursley, Dewayne M. / Choosing wisely in newborn medicine : Five opportunities to increase value. In: Pediatrics. 2015 ; Vol. 136, No. 2. pp. e482-e489.
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