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Published on: February 5, 2019
Traditional Mongolian swaddling and developmental dysplasia of the hip: a randomized controlled trial
Munkhtulga Ulziibat1,2, Bayalag Munkhuu3, Ariun-Erdene Bataa3
1Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland. umunhtulga@gmail.com.
Insights
Traditional Mongolian infant swaddling, which extends legs and adducts hips, significantly increases the risk of developmental dysplasia of the hip (DDH). Avoiding this practice promotes healthier hip development in newborns.
Area of Science:
- Pediatrics
- Orthopedics
- Public Health
Background:
- Mongolian traditional infant swaddling involves tight wrapping with extended limbs and adducted hips.
- This practice is hypothesized to contribute to abnormal hip joint formation and developmental dysplasia of the hip (DDH).
- A randomized controlled trial was designed to test this hypothesis.
Purpose of the Study:
- To investigate the impact of traditional Mongolian swaddling on infant hip development.
- To compare the incidence of hip abnormalities between swaddled and non-swaddled infants.
- To determine the correlation between swaddling practices and the development of DDH.
Main Methods:
- Eighty newborns at risk for DDH (Graf Type 2a) were randomized into two groups: traditional Mongolian swaddling (n=40) and non-swaddling (n=40).
- The swaddling group was managed using the traditional method for one month.
- Infants were monitored monthly via hip ultrasound, with interventions applied as needed; outcomes included Graf's non-Type 1 hips, DDH incidence, and time to discharge (Graf Type 1).
Main Results:
- The swaddling group showed a significantly higher rate of non-Type 1 hips (40%) compared to the non-swaddling group (7.5%) (p=0.001).
- Eight cases of DDH were observed in the swaddling group, versus none in the non-swaddling group.
- Time to hip maturation (discharge) was longer in the swaddling group (8.4 weeks) than the non-swaddling group (5.1 weeks) (p=0.001); significant correlations were found between DDH risk and swaddling frequency/duration.
Conclusions:
- Traditional Mongolian infant swaddling, characterized by hip extension and adduction, is a significant risk factor for developmental dysplasia of the hip.
- Non-swaddling promotes healthier hip maturation and reduces the incidence of DDH.
- The findings support a modification of traditional swaddling practices to prevent DDH.
Background:
Mongolian traditional swaddling of infants, where arms and legs are extended with a tight wrapping and hips are in adduction position, may lead to abnormal maturation and formation of the hip joint; and is a contributing factor for developmental dysplasia of the hip (DDH). This hypothesis was tested in this randomized controlled trial.
Methods:
Eighty newborns with one or two hips at risk of worsening to DDH (Graf Type 2a; physiologically immature hips) at birth were randomized into 2 groups at a tertiary hospital in Ulaanbaatar. The "swaddling" group (n = 40) was swaddled in the common traditional Mongolian method for a month while the "non-swaddling" group (n = 40) was instructed not to swaddle at all. All enrollees were followed up on monthly basis by hip ultrasound and treated with an abduction-flexion splint if necessary. The groups were compared on the rate of Graf's "non-Type 1" hips at follow-up controls as the primary outcome. Secondary outcomes were rate of DDH and time to discharge (Graf Type 1; healthy hips). In addition, correlation between the primary outcome and swaddling length in days and frequency of swaddling in hours per day were calculated.
Results:
Recruitment continued from September 2019 to March 2020 and follow-up data were completed in June 2020. We collected final outcome data in all 80 enrollees. Percentages of cases with non-Type 1 hip at any follow-up examination were 7.5% (3/40) in the non-swaddling group and 40% (16/40) in the swaddling group (p = 0.001). There was no DDH case in the non-swaddling group while there were 8 cases of DDH in the swaddling group. The mean time to discharge was 5.1 ± 0.3 weeks in the non-swaddling group and 8.4 ± 0.89 weeks in the swaddling group (p = 0.001). There is a correlation between the primary outcome and the swaddling frequency in hours per day (r = 0.81) and swaddling length in days (r = 0.43).
Conclusions:
Mongolian traditional swaddling where legs are extended and hips are in extension and adduction position increases the risk for DDH.
Trial Registration:
Retrospectively registered, ISRCTN11228572 .
