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Screening the newborn for developmental dysplasia of the hip: now what do we do?
Richard M Schwend1, Perry Schoenecker, B Stephens Richards
1Section of Orthopaedics, Children's Mercy Hospital, Kansas City, MO, USA. rmschwend@cmh.edu
Insights
Early detection of developmental hip dysplasia (DDH) in infants is crucial. A thorough newborn exam, including the Ortolani maneuver, is key for identifying hip instability, even without risk factors.
Area of Science:
- Pediatric Orthopaedics
- Neonatal Care
- Developmental Biology
Background:
- Developmental hip dysplasia (DDH) affects infants, with most cases occurring without identifiable risk factors.
- Clinical practice guidelines emphasize early detection and management of DDH.
- Standard newborn examinations are vital for identifying hip instability.
Purpose of the Study:
- To reinforce the importance of established clinical guidelines for the early detection of developmental hip dysplasia (DDH) in all infants.
- To highlight the efficacy and safety of early intervention for unstable hips.
Main Methods:
- Adherence to the American Academy of Pediatrics' clinical practice guideline for DDH detection.
- Performance of a competent newborn physical examination, specifically utilizing the Ortolani maneuver.
- Monitoring infants for late-onset hip dislocation despite normal initial examinations.
Main Results:
- The Ortolani maneuver during a newborn physical exam is the most effective method for detecting hip instability.
- Early treatment with a Pavlik harness or similar orthosis is highly effective and safe for unstable hips.
- A small percentage of infants (approximately 1 in 5000) may develop late-onset hip dislocation even after normal initial examinations.
Conclusions:
- Healthcare providers should consistently follow guidelines for early DDH detection in all infants.
- Early intervention for hip instability is strongly advised and proves effective.
- Ongoing vigilance is necessary as late-onset hip dislocation can occur in a small subset of infants.
Abstract:
The Pediatric Orthopaedic Society of North America recommends that all health care providers who are involved in the care of infants continue to follow the clinical practice guideline for early detection of developmental hip dysplasia (DDH) outlined by the American Academy of Pediatrics. Although evaluation of children with risk factors for DDH is important, most DDH occurs in infants who have no risk factors. For all infants, a competent newborn physical examination using the Ortolani maneuver is the most useful procedure to detect hip instability. Early treatment of an unstable hip with a Pavlik harness or similarly effective orthosis is effective, safe, and strongly advised. Despite having had normal newborn and infant hip examinations, there remains the possibility of a late-onset hip dislocation needing treatment in approximately 1 in 5000 infants.
