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Is prematurity a risk factor for developmental dysplasia of the hip? A systematic review and meta-analysis
Robert J Burkhart1, Ryan McNassor, Alexander J Acuña
1Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Insights
Prematurity is not strongly linked to developmental dysplasia of the hip (DDH). This review found no significant difference in DDH rates between preterm and term infants, with some evidence suggesting more mature hips in earlier gestations.
Area of Science:
- Orthopedics and Neonatal Care
Background:
- Developmental dysplasia of the hip (DDH) is a common neonatal orthopedic condition requiring early diagnosis.
- The association between prematurity and DDH is not well-established, despite identified risk factors for DDH.
- This study investigates the relationship between preterm birth and the incidence of DDH.
Approach:
- A systematic literature review was conducted, analyzing 11 studies published between 2000 and 2022.
- Data from 8720 patients, comparing preterm (23-36 weeks gestation) and term (≥37 weeks) infants, were pooled.
- Statistical analysis, including odds ratios (OR) and confidence intervals (CI), was used to assess DDH incidence and hip maturity (Graf classification).
Key Points:
- Pooled analysis of 11 studies (8720 patients) showed no significant difference in DDH rates between preterm and term infants (OR, 1.11; 95% CI, 0.82-1.51).
- Sub-group analysis of very preterm infants (≤32 weeks) also revealed no significant increase in DDH risk compared to term infants.
- Four studies indicated that earlier gestational age was associated with a higher incidence of mature hips, as measured by Graf classification (OR, 0.13; 95% CI, 0.03-0.61).
Conclusions:
- Current literature suggests prematurity is not a significant risk factor for developmental dysplasia of the hip.
- Infants born at earlier gestational ages may exhibit more mature hip development according to the Graf classification.
- Further research may clarify the nuanced relationship between gestational age and hip development in newborns.
Abstract:
Developmental dysplasia of the hip (DDH) is the most common orthopedic disorder in newborns. Early recognition and diagnosis are critical to prevent long-term complications. While several risk factors have been established, the association between prematurity and DDH remains unclear. Our analysis sought to analyze the literature exploring the relationship between prematurity and DDH. Articles evaluating the relationship between prematurity and DDH published between 1 January 2000 and 1 February 2022 were queried, with 11 studies included for analysis. Overall, a total of 8720 patients were included. The gestational age ranged from 23 to 36 weeks for preterm and ≥37 weeks for term births. Seven studies agreed that gestational age did not have a significant impact on DDH. Pooled analysis of available data demonstrated no significant difference in DDH among preterm and term infants (OR, 1.11; 95% CI, 0.82-1.51; P = 0.49). Sub-group analysis of two studies reporting data on very preterm (≤32 weeks) and term infants revealed no significant difference in the occurrence of DDH (OR, 4.58; 95% CI, 0.09-244.78; P = 0.45). Four studies found early gestational age is associated with a significantly higher incidence of mature hips compared to late preterm or term babies. Similarly, pooled analysis demonstrated significantly lower Graf classification among preterm infants (OR, 0.13; 95% CI, 0.03-0.61; P = 0.009). Based on the current literature, our analysis found that prematurity is not strongly associated with DDH. Furthermore, early gestational age was associated with a significantly higher incidence of mature hips measured by Graf classification.
