Preventive health care, 2001 update: screening and management of developmental dysplasia of the hip in newborns (original) (raw)

Evaluation and Referral for Developmental Dysplasia of the Hip in Infants

Pediatrics, 2016

Developmental dysplasia of the hip (DDH) encompasses a wide spectrum of clinical severity, from mild developmental abnormalities to frank dislocation. Clinical hip instability occurs in 1% to 2% of full-term infants, and up to 15% have hip instability or hip immaturity detectable by imaging studies. Hip dysplasia is the most common cause of hip arthritis in women younger than 40 years and accounts for 5% to 10% of all total hip replacements in the United States. Newborn and periodic screening have been practiced for decades, because DDH is clinically silent during the first year of life, can be treated more effectively if detected early, and can have severe consequences if left untreated. However, screening programs and techniques are not uniform, and there is little evidence-based literature to support current practice, leading to controversy. Recent literature shows that many mild forms of DDH resolve without treatment, and there is a lack of agreement on ultrasonographic diagnost...

Developmental dysplasia of the hip in newborns – a still relevant problem

Chirurgia Narządów Ruchu i Ortopedia Polska

Developmental dysplasia of the hip in infants covers a wide range of different clinical severity, from complete dislocation, through subluxation to dysplasia, often of mild degree, which disappears on its own. The consequences of undiagnosed dysplasia may affect the motor skills of a child and an adult. A complete cure of the defect using simple nursing methods is possible only in infancy. The introduction of sonographic imaging facilitated early diagnosis of the defect, which significantly reduced the need for surgical treatment. For this trend to continue early orthopedic and sonographic examination of children with risk factors must be conducted and in Poland this should be a standard for all newborns.

Developmental dysplasia of the hip in the newborn: A systematic review

World journal of orthopedics, 2013

Developmental dysplasia of the hip (DDH) denotes a wide spectrum of conditions ranging from subtle acetabular dysplasia to irreducible hip dislocations. Clinical diagnostic tests complement ultrasound imaging in allowing diagnosis, classification and monitoring of this condition. Classification systems relate to the alpha and beta angles in addition to the dynamic coverage index (DCI). Screening programmes for DDH show considerable geographic variation; certain risk factors have been identified which necessitate ultrasound assessment of the newborn. The treatment of DDH has undergone significant evolution, but the current gold standard is still the Pavlik harness. Duration of Pavlik harness treatment has been reported to range from 3 to 9.3 mo. The beta angle, DCI and the superior/lateral femoral head displacement can be assessed via ultrasound to estimate the likelihood of success. Success rates of between 7% and 99% have been reported when using the harness to treat DDH. Avascular...

Screening of Newborns and Infants for Developmental Dysplasia of the Hip: A Systematic Review

Indian Journal of Orthopaedics, 2021

Background Developmental dysplasia of hip (DDH) is a common disorder of childhood and has a good prognosis when treated at an early age. In spite of being a significant concern, many children with DDH are not picked early and present late at walking age. In our country, it is presumed to be due to absence of a national policy for screening of DDH. Screening programmes including the combination of clinical and radiological methods in different ways have been suggested. However, the exact method of screening is controversial. Purpose To analyze effectiveness and cost-effectiveness of various screening methods for DDH. Study Design Systematic review. Methods This review was conducted in accordance with PRISMA guidelines. Medline database was explored for original case series and randomized clinical trials. Inclusion criteria were English language, screening for DDH in neonates, sample size more than 500, and studies with minimum duration of one year. Results Thirty-four studies were selected to write the manuscript. This included 23 studies looking for effectiveness of a screening programme and 11 studies comparing various outcomes of different screening strategies. A trend favoring universal ultrasound screening was observed Conclusion The literature supports universal ultrasound screening and has proved its cost-effectiveness. However, considering the logistic and financial challenges in our country, immediate implementation of universal ultrasound screening seems impractical. In the absence of any current guidelines for screening for DDH in India, we suggest professional organizations involved in the care of children and public health policy-makers to come together to develop national screening guidelines for DDH.

Evaluation and treatment of developmental hip dysplasia in the newborn and infant

Pediatric clinics of North America, 2014

Developmental dysplasia of the hip (DDH) encompasses a spectrum of physical and imaging findings. The child's hip will not develop normally if it remains unstable and anatomically abnormal by walking age. Therefore, careful physical examination of all infants to diagnosis and treat significant DDH is critical to provide the best possible functional outcome. Regardless of the practice setting, all health professionals who care for newborns and infants should be trained to evaluate the infant hip for instability and to provide appropriate and early conservative treatment or referral.

Diagnosis of congenital hip dysplasia in the newborn

Acta Orthopaedica, 2008

Screening of newborn infants for congenital hip dysplasia may be done by clinical examination, ultrasound, or radiography-or a combination of these. Studies that have used clinical examination followed by ultrasound imaging for infants with certain risk factors have shown excellent results, but they were performed by very experienced practitioners. We wanted to find out whether the results of such screening would be equally good with less optimal staffing. Thus, we evaluated the real-life performance of a screening program for detection of congenital hip dysplasia in newborn infants. Subjects and methods We performed a retrospective chart review of all infants (n = 1,983) referred for evaluation for suspected congenital hip dysplasia from one single obstetric hospital, where 19,820 infants had been screened from 1992 through 2001. Infants were referred either because of a positive finding during the Ortolani and Barlow examinations or because of the presence of risk factors.

Screening for developmental dysplasia of the hip

Seminars in Neonatology, 1998

Key words: congenital dislocation of the hip, developmental dysplasia of the hip, infant, newborn , cost-effectiveness, screening programmes, evaluation studies, ultrasonography

Developmental dysplasia of the hip: Risk markers, clinical screening and outcome

Pediatrics International, 2008

Background: Early detection, diagnosis and treatment of developmental dysplasia/dislocation of hip (DDH) are essential in preventing further disability and quality of life impairment in children. DDH risk markers and association between the age of clinical screening and outcome, were evaluated.Methods: Clinical screening at ages birth, 6 and 13 weeks was performed in 8145 infants by pediatricians. Infants suspected for DDH were referred to the community hospital clinic for clinical evaluation by a pediatric orthopedic surgeon, imaging procedures and follow up. Demographic and perinatal characteristics of the children with suspected (n= 77) and diagnosed DDH (n= 51) were compared to matched controls (n= 154).Results: The rate of suspected DDH was 0.95% and that of diagnosed DDH was 0.63%. Female gender, firstborn child and breech presentation were significantly more frequent among cases versus controls (odds ratio [OR]: 4.3, 2.7, and 6 respectively; P < 0.05). The highest positive predictive value (95.5%) in physical evaluation was any evidence of a dislocatable hip. The proportion of DDH among infants referred from the newborn department was significantly higher (OR, 4.4). DDH diagnosis after 6 weeks of age was associated with a higher likelihood of subsequent surgery and motor disability. Untoward outcome was significantly associated with increasing age of referral both at ages of 6 and 13 weeks (P < 0.05).Conclusions: Children with DDH have certain specific demographic and perinatal risk markers. Clinical screening targeted towards early diagnosis may lessen the need for surgical intervention and the risk of disability or motor handicap.

Risk Factors for Developmental Dysplasia of the Hip : Results from 1025 Neonates

2017

Material and Method: Between August 2010 and March 2011, a single orthopedic surgeon examined 1025 neonates using hip ultrasonography according to the Graf technique. Records of ultrasonographic examination and risk factors were compared. Clinical examination was performed, but findings were not taken into consideration. Results: The mean birth age was 38.3±2.1 (range, 26– 42) weeks and the mean birth weight was 3.2±0.6 (range, 0.8–4.4) kg. Most (94.4%) births were single, 5.5% were twins, and 0.3% were triplets, with55.9% boys and 44.1% girls. The mean age at presentation was 1.7±1.3 (range, 0.3–9) months. Two hundred and twenty-one births were normal and 804 were by caesarean section. DDH prevalence was significantly higher in girls than in boys.