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Diagnosis of congenital hip dysplasia in the newborn
Per Haavwardsholm Finne1, Ingvild Dalen, Nicolaos Ikonomou
1Department of Pediatrics, Rikshospitalet HC, University of Oslo, Oslo, Norway.
Insights
Screening for developmental dysplasia of the hip (DDH) in newborns may be less effective with general pediatric staff compared to specialists. Real-world analysis of screening protocols is crucial for identifying and improving diagnostic quality.
Area of Science:
- Pediatrics
- Orthopedic Surgery
- Medical Imaging
Background:
- Congenital hip dysplasia (CHD) screening in newborns utilizes clinical examination, ultrasound, or radiography.
- Previous studies with experienced practitioners showed excellent results for clinical examination followed by ultrasound for high-risk infants.
Purpose of the Study:
- To evaluate the real-life performance of a screening program for detecting congenital hip dysplasia in newborn infants.
- To determine if screening effectiveness is maintained with less specialized staffing.
Main Methods:
- A retrospective chart review was conducted on 1,983 infants referred for suspected CHD evaluation.
- Infants were referred from a single obstetric hospital (1992-2001) due to positive clinical findings (Ortolani, Barlow) or risk factors.
Main Results:
- 10% of screened infants (1,983/19,820) were referred; 1.3% for clinical signs, 7.8% for risk factors.
- 15% of referred infants (298) required treatment.
- Delayed diagnoses occurred in 1.7 per 1,000 infants.
Conclusions:
- Real-life screening performance for CHD may not meet expectations set in optimized settings with specialized staff.
- Analyzing screening data can identify weaknesses and guide quality improvement adjustments.
Background And Purpose:
Screening of newborn infants for congenital hip dysplasia may be done by clinical examination, ultrasound, or radiography--or a combination of these. Studies that have used clinical examination followed by ultrasound imaging for infants with certain risk factors have shown excellent results, but they were performed by very experienced practitioners. We wanted to find out whether the results of such screening would be equally good with less optimal staffing. Thus, we evaluated the real-life performance of a screening program for detection of congenital hip dysplasia in newborn infants.
Subjects And Methods:
We performed a retrospective chart review of all infants (n = 1,983) referred for evaluation for suspected congenital hip dysplasia from one single obstetric hospital, where 19,820 infants had been screened from 1992 through 2001. Infants were referred either because of a positive finding during the Ortolani and Barlow examinations or because of the presence of risk factors.
Results:
The reasons for referral of the 1,983 infants (10% of those examined) were: positive clinical signs in 255 (1.3% of all examined) and risk factors in 1,547 (7.8%), and a combination of both in 114 (0.6%). 67 other infants (0.3%) who had passed the initial pediatric screening were later referred from the local health centers. Finally, 23 of the 1,983 infants were subsequently referred again by their health center for renewed orthopedic evaluation. Of the infants who were treated (298/1,983 = 15% of those referred), those with a pathological examination result were represented proportionately more than infants who were referred because of risk factors (0.8% as opposed to 0.5%). Delayed diagnoses occurred in 1.7/1,000 infants.
Interpretation:
The performance of a screening protocol for congenital hip dysplasia in a real-life setting involving several physicians both on the pediatric and orthopedic side may not live up to expectations based on the use of such a protocol in an optimized setting. This type of analysis of screening data may serve to pinpoint weaknesses, and thus lead to adjustments that may enhance quality.
