Combined ultrasonographic and clinical evaluation of high risk neonates for developmental dysplasia of hip: a prospective study

ABSTRACT

Developmental dysplasia of the hip [DDH] continues to be missed by routine physical screening examinations in the early months when treatment is most effective. Real time ultrasonography is valuable in detection of DDH in the young infants less than three months old. We performed a prospective study to evaluate the use of ultrasound screening that targets a select [high risk newborn] population for DDH aiming to increase the early diagnosis of this condition and decrease the incidence of late cases. From 2121 live births in our hospitals; we identified 188 [8.8%] newborns with risk factors for DDH. We followed these patients by clinical examination and ultrasound at birth, 6 weeks and 12 weeks of age. Initial ultrasound scan showed that 28% of the cases had findings suggestive of dysplastic hip, about half of them were clinically normal during neonatal examination. On subsequent scanning, the proportion of abnormal hip decreased gradually so that by 12 weeks, 80% had normal ultrasound appearance. Abnormality was more common in babies with breech presentation and family history of DDH. One female infant, not diagnosed by clinical examination at birth and with no risk factors, had abnormal clinical examination and ultrasound appearance of DDH by 12 weeks. From our study, we conclude that selective screening with ultrasound for the hip of newborns with specific physical and historical risk factors for DDH is more effective than clinical screening alone. It targets treatment to these infants who need it, and reveals a number of dislocated and subluxated hips that would otherwise be missed. It is better done when they are 4-6 weeks old. Clinical assessment cannot be restricted only to the first 2-3 days after birth but continued during the first year of life