Related Experiment Videos
Routine ultrasound screening for neonatal hip instability. Can it abolish late-presenting congenital dislocation of
D S Marks1, J Clegg, A N al-Chalabi
1Coventry & Warwickshire Hospital, England, UK.
Insights
Routine ultrasound screening for neonatal hip instability effectively identifies abnormalities in newborns. This method detected cases missed by clinical exams, preventing delayed diagnoses of developmental dysplasia of the hip (CDH).
Area of Science:
- Pediatrics
- Orthopedics
- Medical Imaging
Background:
- Neonatal hip instability, including developmental dysplasia of the hip (CDH), requires early detection to prevent long-term complications.
- Clinical examination alone may miss subtle cases of hip instability.
- Ultrasound screening has emerged as a valuable tool for assessing infant hip development.
Purpose of the Study:
- To evaluate the effectiveness of routine ultrasound screening for neonatal hip instability.
- To assess the incidence and natural progression of hip abnormalities detected by ultrasound.
- To determine the utility of ultrasound in identifying cases not diagnosed clinically.
Main Methods:
- A routine ultrasound screening program for neonatal hip instability was implemented in Coventry starting in June 1989.
- 14,050 infants were scanned in the first three years.
- A grading system based on femoral head coverage was utilized to categorize hip abnormalities.
Main Results:
- 6% (847) of scanned infants showed ultrasound abnormalities.
- The proportion of abnormal hips decreased over time, with 90% appearing normal by nine weeks.
- Abnormalities were more prevalent in infants with a family history of CDH and breech presentations.
- All clinically abnormal hips presented with abnormal ultrasound findings.
- Ultrasound identified five cases with initially normal clinical exams and no risk factors, which later proved to be clinically abnormal hips.
Conclusions:
- Routine ultrasound screening is effective in detecting neonatal hip instability, including cases missed by clinical examination.
- Early ultrasound detection can prevent late presentation and treatment of developmental dysplasia of the hip.
- The study highlights the importance of ultrasound in identifying at-risk infants and those with subclinical hip abnormalities.
Abstract:
We have undertaken routine ultrasound screening for neonatal hip instability in Coventry since June 1989. Of the 14,050 babies scanned during the first three years, 847 (6%) had ultrasound abnormalities. A grading system, based on the percentage of femoral head coverage, is presented. The proportion of abnormal hips decreased gradually so that by nine weeks, 90% had normal ultrasound appearances. Abnormality was more common in babies with a family history of CDH and in breech presentations. All babies with clinically abnormal hips had an abnormal first ultrasound examination. Five babies not diagnosed by clinical examination and with no risk factors had abnormal ultrasound appearances and were subsequently found to have clinically abnormal hips. Routine ultrasound screening has detected cases which would otherwise have presented late.