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Successful screening for neonatal hip instability in Australia
1Women's and Children's Unit, Gippsland Base Hospital, Sale, Victoria, Australia. pwgoss@bigpond.com
Insights
A new screening program for neonatal hip instability (NHI) in Australia detected over 19 cases per 1000 births. This program successfully eliminated late-diagnosed congenital dislocation of the hip (CDH).
Area of Science:
- Pediatrics
- Public Health
- Orthopedics
Background:
- Australian congenital dislocation of the hip (CDH) screening programs show lower neonatal hip instability (NHI) detection rates compared to international benchmarks.
- There is a need to establish the true incidence of NHI in Australian infants and prevent late diagnoses of CDH.
Purpose of the Study:
- To establish the true incidence of neonatal hip instability (NHI) in Australian babies.
- To eliminate late-diagnosed congenital dislocation of the hip (CDH) through a quality, accountable clinical screening program.
Main Methods:
- Doctors were trained and held accountable for NHI detection in 5166 newborns (1989-2000).
- Paediatricians managed confirmed NHI cases, with peer review of detection rates and surveillance for late-diagnosed CDH.
Main Results:
- Neonatal hip instability (NHI) was detected in 19.4 per 1000 infants; 77% were female, 26% breech, and 25% had a family history.
- All detected NHI cases received splinting, with 85% showing no complications at 12 months.
- No cases of late-diagnosed CDH were identified in the study population over 12 years.
Conclusions:
- The true incidence of NHI in Australia is at least 19 per 1000 births.
- Effective clinical screening programs for NHI can be implemented by primary care physicians, potentially eradicating late-diagnosed CDH.
Objective:
Australian screening programmes for congenital dislocation of the hip (CDH) are characterized by lower neonatal hip instability (NHI) detection rates than more successful international programmes. Through creating a quality, accountable clinical screening programme for NHI detection, the present study aimed to establish the true incidence of NHI in Australian babies and to eliminate 'late diagnosed' CDH.
Methods:
Doctors responsible for routine neonatal care were made accountable for NHI detection and examined 5166 consecutive live births in the first days of life between 1989 and 2000. Techniques for clinical NHI detection were taught, and doctors practised with teaching-mannequins. Paediatricians clinically determined true positive NHI cases and managed them for a 12-month period. Peer review of NHI detection rates was introduced to encourage accountability. Surveillance for 'late diagnosed' CDH occurred regularly through a variety of methods.
Results:
One hundred babies with NHI were detected (19.4 per 1000): 77% were female; 26% were breech presentation, 25% had a family history of hip instability; and all received some form of splinting. Follow up for 85% of these babies at 12 months revealed no significant complications. Extensive searching has revealed no baby with 'late diagnosed' CDH from the study population in 12 years. One baby commenced treatment late (at 4 months) because of a failure of process following early NHI detection.
Conclusions:
The true incidence of NHI in Australia is > or =19 per 1000 births. Successful clinical CDH screening programmes using primary care doctors can be created and might eliminate 'late diagnosed' CDH.