{
  "abstract": "Objectives and Study The 2018 ESPGHAN guidelines on paediatric HPN recommend a routine chest X-ray (CXR) every 12 months. 1 Regular imaging can expose children to increased radiation and adds to the financial burden of health care systems. This study evaluates if annual surveillance CXRs impact on patient central venous catheter (CVC) management.Methods 5-year retrospective data collection (2019–2023) from electronic records of all children (age 0-18) receiving HPN in an intestinal failure (IF) centre. All patients with a central venous catheter (CVC) in place for > one year were included. Patient demographics (gender, age), underlying IF diagnosis, annual CXR reports, and corresponding CVC management were recorded.Results A total of 137 routine annual CXR were performed on 54 patients (62% female). IF phenotype was 49/137 (36%) short gut syndrome, 47/137 (34%) gut motility disorders, 30/137 (22%) mucosal disease, 7/137 (5%) haematological conditions, 1/137 (1%) post bone marrow transplantation (BMT), 1/137 (1%) immunological condition, 2/137 (1 %) neurodevelopmental disorder.129/137 (94%) CXRs did not result in a CVC intervention. Only 3% of 137 x-rays, affecting 4 patients, had a CVC change carried out based on the CXR result. 1/4 children underwent CXR due to clinical symptoms (pain at CVC site) and 1/4 children had suspected cuff migration, which coincided with their annual surveillance image. Only 1/54 patients (0.7% of x-rays) underwent a CVC replacement as a direct outcome of the CXR findings (displaced CVC, 1/54 patients (1/137 x-rays) underwent a CVC repair after catheter blockage identified on annual CXR.Conclusions Routine annual chest X-rays may be unnecessary in asymptomatic patients on long-term PN and could be limited to symptomatic patients and to those during periods of rapid growth, when there is a higher risk CVC tip migration. Adopting a more selective approach could lower radiation exposure and alleviate the economic burden on healthcare providers.Reference Hill S, Ksiazyk J, Prell C, Tabbers M. ESPGHAN/ESPEN/ESPR/CSPEN working group on pediatric parenteral nutrition. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Home parenteral nutrition. Clin Nutr. 2018 Dec;37(6 Pt B):2401–2408.",
  "authors": [
    {
      "affiliations": [
        "Great Ormond Street Hospital"
      ],
      "name": "Micol Sonnino"
    },
    {
      "affiliations": [
        "Great Ormond Street Hospital"
      ],
      "name": "Hannah Littlechild"
    },
    {
      "affiliations": [
        "Great Ormond Street Hospital"
      ],
      "name": "Sophie Montgomery-Stuart"
    },
    {
      "affiliations": [
        "Great Ormond Street Hospital"
      ],
      "name": "Rulla Al-Araji"
    },
    {
      "affiliations": [
        "Great Ormond Street Hospital"
      ],
      "name": "Susan Hill"
    },
    {
      "affiliations": [
        "Great Ormond Street Hospital"
      ],
      "name": "Jutta Koeglmeier"
    }
  ],
  "title": "OC76 Routine surveillance CXR in children on home parenteral nutrition (HPN) – unnecessary radiation?",
  "uid": "378c5ea6-e999-5013-bc8a-529ca8b9eebd"
}