American Academy of Pediatrics – Section on Perinatal Pediatrics

View all recommendations from this society

Released July 20, 2015

Avoid routine daily chest radiographs without an indication for intubated infants.

Although intermittent chest radiographs may identify unexpected findings, there is no evidence documenting the effectiveness of daily chest X-rays to reduce adverse outcomes. Further, this practice is associated with increased radiation exposure.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Academy of Pediatrics Section on Perinatal Pediatrics (SoPPe) Executive Committee employed a national survey of representative newborn medicine providers from SoPPe and the Vermont-Oxford Network. Survey recipients were asked to consider the range of testing and treatments conducted on high and low risk newborns. They were then asked them to provide examples of tests and treatments that, in their opinion, best met any or all of the following criteria: there is evidence of lack of efficacy, there is insufficient evidence of efficacy, or the test or treatment unnecessarily utilized staffing or material resources. Among the recipients, 1047 responded with a total of 2870 suggestions of tests and treatments. These responses were then collated and presented to an expert panel of 51 individuals representing 28 national and regional stakeholder perinatal care organizations. A modified Delphi process utilizing electronic survey techniques was used to narrow the list to the Top 5 over three rounds. During the initial round, the panel reduced the top 22 general categories of tests and treatments to 13. The reintroduction of specific clinical contexts, derived from the original survey, resulted in 24 items that were reduced to 12 in the second round. In the final round, the panel was provided with GRADE (Grades of Recommendation, Assessment, Development and Evaluation) literature summaries of the top 12 to ensure that all current evidence was considered. The final list was reviewed and approved by the Academy’s Board of Directors and Executive Committee.

AAP’s disclosure and conflict of interest policy can be found at www.aap.org.

Sources

Greenough A, Dimitriou G, Alvares BR, Karani J. Routine daily chest radiographs in ventilated, very low birth weight infants. Eur J Pediatr. 2001 Mar;160(3):147-9.

Spitzer AR, Greer JG, Antunes M, Szema KF, Gross GW. The clinical value of screening chest radiography in the neonate with lung disease. Clin Pediatr (Phila). 1993 Sep;32(9):514-9.