Management issues of congenital talipes equinovarus in the neonatal intensive care unit: A systematic review
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Sally M Trout1, Amanda T Whitaker2
1The Ohio State University College of Medicine, Columbus, OH, USA.
Insights
The Ponseti method can be initiated in the neonatal intensive care unit (NICU) for infants with clubfoot, showing good outcomes. This approach may reduce the need for surgery without disrupting critical medical care.
Area of Science:
- Pediatric Orthopedics
- Neonatal Care
Background:
- Idiopathic congenital talipes equinovarus (clubfoot) is typically managed with the Ponseti method in outpatient settings.
- Clinical guidelines for inpatient clubfoot treatment, particularly in the neonatal intensive care unit (NICU), are lacking.
- Medical reasons often lead to delayed treatment initiation for neonates with clubfoot in the NICU.
Purpose of the Study:
- To systematically review literature on treating clubfoot within the NICU setting.
- To investigate the efficacy of the Ponseti method for non-idiopathic and delayed-presentation clubfoot.
- To identify barriers to care for clubfoot treatment in neonates.
Main Methods:
- Systematic literature review.
- Analysis of studies on NICU clubfoot treatment, non-idiopathic cases, and older infants.
- Examination of barriers to care.
Main Results:
- The Ponseti method yields good functional outcomes in a mixed NICU population (syndromic and idiopathic clubfoot) with minimal impact on medical management.
- The Ponseti method demonstrates good functional outcomes and reduces the need for extensive surgery in non-idiopathic clubfoot and delayed-presentation idiopathic clubfoot (under one year).
Conclusions:
- Initiating Ponseti treatment in the NICU is feasible without compromising essential medical management.
- The potential advantages of early NICU Ponseti treatment versus delayed outpatient casting require further investigation.
Background:
The Ponseti method is the standard of care for managing idiopathic congenital talipes equinovarus (clubfoot) in the outpatient setting, but there are no clinical guidelines for inpatient treatment. Children in the neonatal intensive care unit (NICU) with clubfoot often delay treatment initiation due to medical reasons.
Methods:
We systematically reviewed literature related to the treatment of clubfoot in the NICU, non-idiopathic clubfoot, and older infants, as well as barriers to care.
Results:
In a mixed NICU population of syndromic and idiopathic clubfoot, the Ponseti method has good functional outcomes with minimal interference with medical management. The Ponseti method has good functional outcomes with reduced need for extensive surgical procedures in non-idiopathic clubfoot and idiopathic clubfoot with delayed presentation (under one year of age).
Conclusions:
It is possible to begin Ponseti treatment in the NICU without compromising medical management. It is not clear if this confers an advantage over waiting for outpatient casting.
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