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CHEST X-RAYS ARE OFTEN UNNECESSARY IN FEBRILE NEONATES.

Febrile neonates often receive an extensive work-up to diagnose the cause of their fever. A chest x-ray is commonly included, but is it necessary when the infant has no evidence of pulmonary disease? This study compared clinical and x-ray findings in 242 febrile infants less than 8 weeks of age who were seen at the Bronx Municipal Hospital Center over a 3-year period. Technically adequate chest x-rays were obtained for 228 infants; 201 (88 percent) were negative. Respiratory signs (cough, tachypnea, rales, retractions, rhonchi, and rhinorrhea) were significantly correlated with a positive chest x-ray: x-rays were positive in 25 (31 percent) of the 80 neonates with at least one respiratory sign, but in only 2 (1 percent) of 148 babies without respiratory signs. Wheezing was the only respiratory sign not associated with a positive x-ray. The more respiratory signs present, the greater the likelihood of a positive x-ray: only 9 percent of babies with a single sign had a positive x-ray, versus 74 percent of those with three or more signs.

Because 99 percent of the febrile neonates without signs or symptoms of pulmonary disease had normal chest x-rays, the authors conclude that routine chest x-rays are unnecessary in such patients.

— RAD

Published in Journal Watch General Medicine October 29, 1991

Citation(s):

Crain EF et al. Is a chest radiograph necessary in the evaluation of every febrile infant less than 8 weeks of age. Pediatrics 1991 Oct 88 821-824.

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