ABSTRACT
OBJECTIVE: We conducted a blinded, randomized, controlled trial to examine whether mildly dysplastic but stable or instable hips would benefit from early treatment, as compared with watchful waiting. PATIENTS AND METHODS: A total of 128 newborns with mild hip dysplasia (sonographic inclination angle [alpha angle] of 43 degrees -49 degrees ) and stable or instable but not dislocatable hips were randomly assigned to receive either 6 weeks of abduction treatment (immediate-treatment group) or follow-up alone (active-sonographic-surveillance group). The main outcome measurement was the acetabular inclination angle, measured by radiograph, at 1 year of age. RESULTS: Both groups included 64 newborns, and there was no loss to follow-up. With the exception of a small but statistically significant excess of girls in the active-sonographic-surveillance group, there were no statistically significant differences in baseline characteristics between the 2 groups. The mean inclination angle at 12 months was 24.2 degrees for both groups (difference: 0.1 [95% confidence interval (CI): -0.8 to 0.9]), and all children had improved and were without treatment. The mean alpha angle was 59.7 degrees in the treatment group and 57.1 degrees in the active-surveillance group for a difference of 2.6 degrees evaluated after 1.5 and 3 months (95% CI: 1.8 to 3.4; P < .001). At 1.5 months of age, the hips had improved in all treated children but not in 5 children under active surveillance (P = .06). Among the sonographic-surveillance group, 47% received treatment after the initial surveillance period of 1.5 months. CONCLUSIONS: Active-sonographic-surveillance halved the number of children requiring treatment, did not increase the duration of treatment, and yielded similar results at 1-year follow-up. Given a reported prevalence of 1.3% for mildly dysplastic but stable hips, a strategy of active surveillance would reduce the overall treatment rate by 0.6%. Our results may have important implications for families as well as for health care costs.
Subject(s)
Hip Dislocation, Congenital/diagnostic imaging , Hip Dislocation, Congenital/therapy , Motion Therapy, Continuous Passive/methods , Observation/methods , Double-Blind Method , Female , Follow-Up Studies , Hip Dislocation, Congenital/physiopathology , Humans , Infant , Infant, Newborn , Male , Probability , Range of Motion, Articular , Recovery of Function , Reference Values , Risk Assessment , Severity of Illness Index , Time Factors , Treatment Outcome , UltrasonographyABSTRACT
BACKGROUND: Few patients with Kawasaki's syndrome have been described in Norway. Different aspects of diagnosis and treatment are assessed in this article. MATERIAL AND METHODS: We retrospectively reviewed 26 cases of Kawasaki's syndrome at Haukeland University Hospital 1985-1999. RESULTS: 85% of the patients fulfilled all criteria for diagnosis and were treated as recommended; yet we found a high frequency of coronary aneurysms (22%). Children with aneurysms had delayed onset of treatment compared to patients without complications. Infants were treated later and had a higher incidence of aneurysms. Laboratory findings differed among infants and older children, and in patients with or without aneurysms. INTERPRETATION: Kawasaki's syndrome is still a clinical diagnosis. Laboratory tests may, however, help to identify patients with high risk of complications. Infants should be followed carefully in the acute phase of febrile illness and be treated early, even when the presentation is atypical. Early adequate treatment is of vital importance to avoid complications and reduce short and longterm morbidity.
