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Am J Perinatol 2016; 33(11): 1035-1039
DOI: 10.1055/s-0036-1586114
Editorial
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Selected Advances and Dilemmas in Neonatal and Perinatal Medicine 2016

Authors

  • Avroy A. Fanaroff

    1   Division of Neonatology, Rainbow Babies and Children's Hospital, Cleveland, Ohio
    2   Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Publication History

Publication Date:
07 September 2016 (online)

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Choosing Wisely

Following the example of the American Board of Internal Medicine Foundation's “Choosing Wisely” campaign, which encourages “physicians, patients, and other health care stakeholders to think and talk about medical tests and procedures that may be unnecessary,” the American Academy of Pediatrics (AAP) joined the Choosing Wisely campaign in 2013. The “Choosing Wisely” campaign charges medical societies with identifying the use of unnecessary tests and treatments which contribute to health care waste. Ho et al[1] reported on the initial series of tests and treatments that could not be justified on the basis of efficacy, safety, or cost. In neonates: The 51 person expert panel achieved consensus on the following top five 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 magnetic resonance imaging in preterm infants.

By following these guidelines, patient safety will not be compromised, but costs will be reduced. There is a reason for optimism that the “Choosing Wisely” program will be accepted in the neonatal community as neonatologists are comfortable when guided by “evidence.” Neonatology has recently not found magical bullets of the caliber of antenatal corticosteroids, surfactant therapy, continuous positive airway pressure (CPAP), and hypothermia for hypoxic–ischemic encephalopathy. To optimize outcomes we need to practice safely and as a comprehensive team applying the evidence and guidelines that are available. “Choosing Wisely” adds baby steps to these endeavors.