Chest radiographs after removal of chest drains in neonates: clinical benefit or common practice?

Full Abstract

BACKGROUND:
Chest drain insertion is a common procedure in neonatal care. Routine radiography after removal of chest drains increases radiation exposure, handling and cost, but there are few data proving clinical benefit.

OBJECTIVES:
To review current practice and determine the yield of routinely obtained chest radiographs (CXR).

METHODS:
A retrospective chart review of all infants undergoing removal of chest tubes in a single tertiary neonatal unit in New Zealand between January 1998 and July 2004 was performed.

RESULTS:
In total, 119 infants were identified, from the database, to have a chest drainage performed. In 19 cases, the procedure was needle aspiration or the drain was removed outside of our unit, hence these were excluded. The remaining 100 patients with 110 episodes of chest drain removal after 174 chest tube insertions were analysed. In asymptomatic infants, routine radiography showed some reaccumulation of air in nine of 35 cases of pneumothorax or of fluid in two of the five cases of pleural effusion, but chest tube reinsertion was not required. In the 12 clinically symptomatic infants, chest tubes were reinserted in five cases (four reaccumulations of pneumothorax and one pleural effusion), and one infant had symptomatic right upper lobe collapse. In the remaining infants, there were no abnormalities on CXR accounting for deterioration.

CONCLUSIONS:
Given the low yield for routine radiography after chest drain removal, we suggest that close observation is likely to detect clinically relevant recurrence of pneumothorax.

Learn Faster Today Improve your study skills

Author information

Author/s: van den Boom, J (J); Battin, M (M);

Affiliation: Newborn Services, Auckland City Hospital, Auckland, New Zealand. juttavdb(-atsign-)adhb.govt.nz

Journal and publication information

Publication Type: Journal Article

Journal: Archives of disease in childhood. Fetal and neonatal edition (Arch Dis Child Fetal Neonatal Ed), published in England. (Language: eng)

Reference: 2007-Jan; vol 92 (issue 1) : pp F46-8

Dates: Created 2006/12/22; Completed 2007/01/25;

PMID: 16769712, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

External Links for this article (including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Pleural Effusion - radiography; therapy
Pneumothorax - radiography; therapy
Radiography, Thoracic
Recurrence
Retrospective Studies

These are the highest related articles currently in the database:

[Neonatal pneumothorax] 2 Dec 2000
Methods of delivery and resuscitation of very-low-birthweight infants in Victoria: 1982-1985. 3 Feb 1990
[Resuscitation of newborn infants] 28 Jun 1994
Early nasal continuous positive airway pressure treatment reduces the need for intubation in very low birth weight infants. 29 Apr 1997
[Early discharge from maternity and neonatal care units--limitations and perspectives] 18 May 1999
Very-low-birth-weight infants in South Africa. 30 Oct 1999
Clinical and economic outcomes of infants receiving breast milk in the NICU. 30 Dec 2000
Vigilant watching over: mothers' actions to safeguard their premature babies in the newborn intensive care nursery. 29 Nov 2001
Reflections on neonatal intensive care in the U.S.: limited success or success with limits? 30 Dec 2000
Cost analysis of a neonatal point-of-care monitor. 29 Apr 2002

See 100+ related articles.