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Predicting developmental dysplasia of the hip in at-risk newborns
Andreas Roposch1,2, Evangelia Protopapa3, Olivia Malaga-Shaw4
1Institute of Child Health, University College London, 30 Guildford St, London, WC1N 3EH, UK. a.roposch@ucl.ac.uk.
Insights
A new risk model accurately predicts developmental dysplasia of the hip (DDH) in newborns within 8 weeks postpartum. This tool aids clinicians in better counseling parents and making informed decisions for at-risk infants.
Area of Science:
- Orthopedics
- Pediatrics
- Medical Prediction Models
Background:
- Developmental dysplasia of the hip (DDH) has multiple risk factors, often acting in combination.
- Clinical prediction of DDH likelihood is frequently inaccurate, with clinicians over- or underestimating risk.
- Accurate prediction is crucial for timely intervention in at-risk newborns.
Purpose of the Study:
- To develop and validate a risk prediction model for developmental dysplasia of the hip (DDH).
- To identify key predictors of DDH in newborns at-risk.
- To enable accurate risk assessment within 8 weeks postpartum.
Main Methods:
- Prospective cohort study involving 13,276 at-risk newborns.
- Enrollment of 2,191 newborns with predefined risk factors or abnormal hip examination.
- Development of a risk model using 9 candidate predictors and variables available at childbirth.
Main Results:
- The final risk model incorporated female sex, family history of DDH, birthweight >4000g, and abnormal hip examination.
- Female sex (OR=5.6) and abnormal hip examination (OR=58.8) were significant predictors.
- The model demonstrated excellent discrimination (C-statistic=0.9) and calibration.
Conclusions:
- A validated risk model quantifies the absolute risk of DDH in at-risk newborns within 8 weeks postpartum.
- The model utilizes readily available clinical variables at childbirth for enhanced parental counseling.
- This tool can support real-time clinical decisions before hospital discharge.
Background:
The development of developmental dysplasia of the hip can be attributed to several risk factors and often in combination with each other. When predicting the likelihood of developing this condition, clinicians tend to over and underestimate its likelihood of occurring. Therefore, the study aim is to determine among at-risk newborns how to best predict developmental dysplasia of the hip (DDH) within 8 weeks post-partum.
Methods:
Prospective cohort study in secondary care. Patient population included newborns at-risk for DDH - we assessed 13,276 consecutive newborns for the presence of DDH risk factors. Only newborns with at least one of the predefined risk factors and those showing an abnormal examination of the hip were enrolled (n = 2191). For the development of a risk prediction model we considered 9 candidate predictors and other variables readily available at childbirth. The main outcome measure was ultrasonography at a median age of 8 weeks using consensus diagnostic criteria; outcome assessors were blinded.
Results:
The risk model includes four predictors: female sex (OR = 5.6; 95% CI: 2.9-10.9; P < 0.001); first degree family history of DDH (OR = 4.5; 95% CI: 2.3-9.0; P < 0.001), birthweight > 4000 g (OR = 1.6; 95% CI: 0.6-4.2; P = 0.34), and abnormal examination of hip (OR = 58.8; 95% CI: 31.9, 108.5; P < 0.001). This model demonstrated excellent discrimination (C statistic = 0.9) and calibration of observed and predicted risk (P = 0.35). A model without the variable 'hip examination' demonstrated similar performance.
Conclusion:
The risk model quantifies absolute risk of DDH within 8 weeks postpartum in at-risk newborns. Based on clinical variables readily available at the point of childbirth, the model will enhance parental counselling and could serve as the basis for real time decisions prior to discharge from maternity wards.
