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Hip abnormalities detected by ultrasound in clinically normal newborn infants
T Terjesen1, K J Holen, A Tegnander
1Trondheim University Hospital, Norway.
Insights
Newborn infants with abnormal hip ultrasounds but normal clinical exams often resolve spontaneously. Treatment for hip abnormalities should be delayed until 4-5 months, based on both ultrasound and radiographic evidence.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
Background:
- Congenital hip abnormalities can be detected via ultrasound in newborns.
- Clinical examination may not reveal hip abnormalities identified by ultrasound.
Purpose of the Study:
- To evaluate the natural progression of hip abnormalities detected by ultrasound in clinically normal newborns.
- To establish optimal timing and criteria for initiating treatment for such cases.
Main Methods:
- Followed 306 infants with abnormal hip ultrasounds out of 9952 newborns over six years.
- Repeated ultrasounds at 2-3 months and radiography at 4-5 months for persistent abnormalities.
- Initiated treatment with abduction splints for infants with confirmed abnormalities on both ultrasound and radiography.
Main Results:
- Most infants (291/306) showed normal hip development by follow-up.
- Only 15 infants had persistent hip abnormalities; none developed dislocations.
- All treated infants showed normalization of hip development after splinting.
Conclusions:
- Newborns with abnormal ultrasound findings but normal clinical exams do not require immediate treatment.
- Delayed treatment (4-5 months) is effective for persistent hip abnormalities, guided by combined ultrasound and radiographic criteria.
- Spontaneous resolution is common, and early intervention is often unnecessary unless clinical instability or dislocation is present.
Abstract:
We have followed the natural progress of newborn infants in whom ultrasound examination showed abnormalities in hips which appeared to be clinically normal. Over six years we saw 306 such children out of 9952 examined (31 per 1000 live births). The examination was repeated at two to three months and those who still showed an abnormality were followed up further. At four to five months a standard radiograph was obtained, and treatment began if this and another ultrasound scan were both abnormal. At this stage, 291 infants had normal hips. In the 15 infants with abnormal hips there was no pronounced deterioration, none developed a frank dislocation, and all became normal after treatment in an abduction splint. Newborn infants with abnormal and suspicious ultrasound findings who are normal on clinical examination do not need treatment from birth; most of these hips will settle spontaneously. Treatment can be postponed until the age of four to five months unless clinical instability develops or ultrasound shows dislocation. The criteria for treatment should be based on measurements by both ultrasound and radiography: both should show an abnormality before intervention is considered necessary.