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Risk factors of developmental dysplasia of the hip in infants: A meta-analysis based on cohort studies
Xingguang Chen1, Jue Liu2, Mingfeng Xue1
1Department of Orthopedics, The Second Affiliated Hospital of Jiaxing University, 314000 Jiaxing, China.
Insights
This meta-analysis identified key risk factors for developmental dysplasia of the hip (DDH) in infants, including being female, breech delivery, and family history. Premature delivery was found to be a protective factor against DDH.
Area of Science:
- Pediatrics
- Orthopedics
- Public Health
Background:
- Developmental dysplasia of the hip (DDH) is a common childhood condition with an uncertain etiology.
- Early identification of risk factors is crucial for targeted screening and diagnosis of DDH.
- This study addresses the need for a comprehensive understanding of DDH risk factors.
Purpose of the Study:
- To conduct a meta-analysis investigating risk factors associated with infant DDH.
- To provide a theoretical foundation for early screening and diagnosis of DDH.
- To synthesize evidence from multiple cohort studies on DDH etiology.
Main Methods:
- Systematic search of multiple databases (PubMed, Embase, CNKI, etc.) up to May 2023.
- Inclusion of cohort studies analyzing risk factors for DDH using logistic regression.
- Data extraction and quality assessment using the Newcastle-Ottawa Scale (NOS).
Main Results:
- Analysis of 11 studies involving 979,757 infants.
- Significant risk factors for DDH include female sex (OR=6.97), breech delivery (OR=4.14), positive family history (OR=4.07), cesarean section (OR=1.11), oligohydramnios (OR=3.93), swaddling (OR=6.74), firstborn status (OR=1.84), and musculoskeletal malformations (OR=2.27).
- Premature delivery (OR=0.91) demonstrated a protective effect against DDH.
Conclusions:
- Female sex, breech delivery, positive family history, cesarean section, firstborn status, oligohydramnios, swaddling, and combined musculoskeletal malformations are significantly associated with DDH.
- Premature delivery acts as a protective factor for DDH.
- Further research is needed to clarify the roles of multiple pregnancies and low birth weight in DDH development.
Introduction:
Developmental dysplasia of the hip (DDH) is a prevalent condition in children. Currently, the exact etiology of DDH remains uncertain. The objective of this study was to conduct a meta-analysis to investigate the risk factors associated with DDH in infants. The findings would provide a theoretical foundation for targeted early screening and diagnosis.
Hypothesis:
Several indicators, such as gender, intrauterine position, family history of DDH, gestational age, delivery mode, amniotic fluid levels, swaddling, parity, fetus number, combined musculoskeletal deformities, birth weight, and physical examination results, may serve as risk factors for DDH.
Materials And Methods:
Cohort studies investigating the risk factors of DDH in infants through logistic regression analysis were searched in the Wanfang, VIP citation, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc, Excerpta Medica Database (Embase), PubMed, and Cochrane Library databases up to May 2023. After extracting the data from eligible literature and assessing them using the Newcastle-Ottawa Scale (NOS), articles were selected based on pre-established inclusion and exclusion criteria.
Results:
A total of eleven literature reports covering 979,757 infants were included in this meta-analysis. The publication bias did not significantly influence the results. The incidence rate of DDH was 47.99‰ among infants with risk factors compared to 3.21‰ in the general population. Risk factors for DDH included being female (OR=6.97, 95% CI: 5.18-9.39, p<0.001), breech delivery (OR=4.14, 95% CI: 3.09-5.54, p<0.001), positive family history (OR=4.07, 95% CI: 2.20-7.52, p<0.001), cesarean section (OR=1.11, 95% CI: 1.01-1.21, p=0.032), oligohydramnios (OR=3.93, 95% CI: 1.29-12.01, p=0.016), swaddling (OR=6.74, 95% CI: 1.25-36.31, p=0.026), firstborn status (OR=1.84, 95% CI: 1.49-2.53, p<0.001), combined musculoskeletal malformations (OR=2.27, 95% CI: 1.58-3.27, p<0.001), and physical signs of DDH (OR=8.71, 95% CI: 2.44-31.07, p=0.001). Premature delivery (OR=0.91, 95% CI: 0.88-0.95, p<0.001) was a protective factor for DDH. The relationship between multiple pregnancies (OR=0.58, 95% CI: 0.33-1.02, p=0.060) and low birth weight (OR=0.62, 95% CI: 0.14-2.76, p=0.529) in relation to DDH remained uncertain.
Discussion:
This meta-analysis shows that female, breech delivery, positive family history, cesarean section, firstborn status, oligohydramnios, swaddling and combined musculoskeletal malformations are associated with DDH. Premature delivery appeared to be a protective factor against DDH. Nevertheless, the other factors need more research to reach more conclusive results.
Level Of Evidence:
III; meta-analysis.
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