Khawaja Ahmad Irfan Waheed, Rahul Velinenibov Jani.
Is early ultrasound screening for developmental dysplasia of the hip necessary?.
Pak Paed J Jan ;32(2):87-93.

Objective: To determine the usefulness of early ultrasound, after birth, in screening for DDH. Design: Observational study. Place and duration of study: Oliver Fisher Neonatal Unit, Medway Maritime Hospital, Gillingham, Kent, UK, between January 2003 to June 2005. Patients and methods: Those babies were included in that were born alive during the study period, to residents of Medway and Swale areas. They had either evidence of unstable hips on clinical examination (Group A) or had at least one, out of a list of three high risk factor for DDH (Group B). Babies who failed their appointments were excluded. The ultrasound scans of the hip joints were done, in Group A babies, within first week after birth and were termed as `urgent scans`. In Group B, the first scans were scheduled at age of 4-6 weeks and were labelled as `routine scans`. Depending upon the group of patients, further scans were done at 3-6 weeks, 8 weeks and 12 weeks of age. The departmental records, information provided by the orthopaedics department and the patient records held in the ultrasound department were used for obtaining their data and results. Results: A total of 10419 babies were born alive in the hospital during the study period. Inclusion criteria were met by 578 babies. There were 74 (12.8%) babies in Group A and 504 (87.1%) babies in Group B. Breech presentation was seen in 58.8% (N=340) babies of Group B and 28.3% (N=164) had a family history of unstable hip joints. Girls constituted 57.2% (N=331) of total number. Because of lack of compliance to ultrasound appointments, 54 babies from Group A and 43 from Group B were excluded from the study. In Group A, 95% babies had abnormal urgent hip scans. The number of abnormal scans reduced to 25% at 4-6 weeks without any intervention (p-value <0.05). In its comparison, 12.7% of Group B babies had abnormal hip scans at 4-6 weeks (p-value = 0.11). Female infants were found in higher proportion in all the abnormal scans. Conclusion: Ultrasound scanning, within first week after birth, offers no additional advantage in babies that have evidence of DDH on clinical examination. The majority of babies with abnormal early scans become normal by 4-6 weeks due to spontaneous correction and hence early scans are unnecessary.

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