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In 2010, Dr Howard Brody introduced the idea of “the top 5 list” in the New England Journal of Medicine, calling on medical specialties to identify items of overuse to provide high-value care.1 This led to the “choosing wisely” campaign to identify commonly overused measures in medicine in >70 different medical specialties.1 One aspect of this campaign is the “Things We Do For No Reason” articles in the Journal of Hospital Medicine, which focus on the evidence behind common overuse, overdiagnosis, or high-value care issues. These discussions are an important part of pediatric hospital medicine, and efforts to promote this subject must continue. As hospitalists, we also have an obligation to reassess things we should be doing. We will discuss 3 examples briefly in this article but encourage this discussion to continue, at conferences, meetings, and break rooms everywhere.
Enteral Tubes in Bronchiolitis Management
Bronchiolitis is the most common reason infants are hospitalized, and over half require nonoral hydration.2,3 Multiple studies have shown that enteral and nasogastric hydration is comparable to intravenous (IV) hydration in terms of safety and tolerance.2,4,5 A large, randomized controlled trial of infants hospitalized with bronchiolitis did not reveal any significant difference in rates of ICU admission, oxygen therapy duration, ventilator support requirement, or length of stay when comparing IV with nasogastric hydration.2
In a 2018 survey, only 12% of physicians and nurses would choose nasogastric hydration for a healthy infant with bronchiolitis.6 Many practitioners reported concerns about nasal obstruction, parental resistance, and aspiration risk, and 66% did not know that nasogastric hydration was a documented …
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