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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Hip Click in the Neonate: Should I Be Concerned?
Insights
Developmental dysplasia of the hip (DDH) needs prompt diagnosis and treatment for best outcomes. Early ultrasound screening is valuable but requires careful use, as many neonatal abnormalities resolve spontaneously.
Area of Science:
- Pediatric Orthopedics
- Neonatal Screening
- Developmental Biology
Background:
- Developmental dysplasia of the hip (DDH) affects 4-133/1,000 newborns, influenced by risk factors like female gender, breech birth, and family history.
- Associated conditions include metatarsus adductus, oligohydramnios, and muscular torticollis.
- Classic physical examination findings for DDH can be challenging to elicit accurately.
Observation:
- Ultrasound screening is a key tool for identifying early hip dysplasia and dislocation.
- Inappropriate use of ultrasound can lead to misleading results.
- Many ultrasound abnormalities detected in the early neonatal period resolve spontaneously.
Findings:
- Early ultrasound is effective for identifying unstable hips and guiding treatment decisions.
- Ortolani/Barlow negative hips with persistent concerns warrant evaluation around 6 weeks of age.
- Treatment modalities like the Pavlik harness and abduction splints offer excellent outcomes but carry inherent risks.
Implications:
- Optimizing DDH outcomes relies on precise evaluation and timely specialist referral.
- Understanding the transient nature of some neonatal hip ultrasound findings is crucial for appropriate management.
- While effective, standard DDH treatments necessitate careful consideration of potential risks.
Abstract:
Developmental dysplasia of the hip (DDH) requires precise evaluation and rapid treatment/referral to specialists to optimize results. The incidence of DDH ranges between 4/1,000 and 133/1,000 newborns depending on patient risk factors (female gender, breech birth, and family history). Multiple associations have been identified including metatarsus adductus, oligohydramnios, and muscular torticollis. Classic physical examination results are well known by pediatricians, but can be difficult to elicit. Ultrasound screening is a useful test in defining early dysplasia and dislocation, but can generate misleading results if used inappropriately. Early ultrasound is useful for the identification of unstable hips and discerning treatment. High rates of ultrasound abnormalities have been identified in the early neonatal period, most of which have been shown to spontaneously improve. Ortolani/Barlow negative hips are best evaluated at age 6 weeks if continued concern is present. Treatment with the Pavlik harness or an abduction splint is well known to have excellent outcomes, but not without risk.
