Neonatal hip instability in Saudi Arabia: Results and cost effectiveness

The benefits of screening hips at birth for congenital dislocation have been repeatedly confirmed but doubts have been raised about the need for splinting all positive cases. Experience from an ongoing screening program, now in operation for over 11 years, is presented particularly with reference to cost benefit of screening and early surgical intervention. Of 30,651 live born babies screened for congenital dislocation of the hip [CDH] employing Barlow and Ortolani maneuvers, 132 were found to be positive, giving an incidence of two to six per 1000 live births, averaging 4.3/1000 for the period. The implications of epidemiologic and clinical observations and of management have been discussed. The cost of screening and of surgical management of cases that would not have stabilized without splinting has been resolved, even assuming that three of four positive cases might have stabilized without intervention. Cost effectiveness of a screening program for CDH was observed from this 11 year study, fully justifying a sustained program apart from the human misery an overlooked diagnosis may cause

Congenital diaphragmatic hernia: update on regional experience

A consecutive series of 34 patients with congenital diaphragmatic hernia are reported from a tertiary neonatal care unit in the Eastern Province. All the patients presented within the first 24 hours of life with left-sided defect. The overall mortality [56%] and postoperative mortality [44%] are comparable with reports from other centers. The outcome of treatment correlated well with the age on presentation, the size of the defect, and preoperative blood gas results. Our approach to management has been modified lately, in the light of recent experience from other centers. The surgery is delayed until the neonate is stabilized with biochemical values of PaCO[2] = 45 torr or less; pH = 7.2 or higher; and PaO[2] = 50 torr or more. This management policy did not adversely affect overall survival. The problems encountered with patient transfer and the need for continued improvement in the organization of regionalized care are highlighted