Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Risk factors and screening timing for developmental dysplasia of the hip in preterm infants

  • Jeon, Ga Won (Department of Pediatrics, Inha University Hospital, Inha University College of Medicine) ;
  • Choo, Hye Jung (Department of Radiology, Inje University Busan Paik Hospital, Inje University College of Medicine) ;
  • Kwon, Yong Uk (Department of Orthopaedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine)
  • Received : 2021.07.31
  • Accepted : 2021.10.12
  • Published : 2022.05.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The delayed diagnosis of developmental dysplasia of the hip (DDH) requires complex treatment and sometimes progresses to hip osteoarthritis. Purpose: This study aimed to evaluate the risk factors and screening time for DDH in preterm infants. Methods: A total of 155 preterm infants with a gestational age <32 weeks screened for DDH with ultrasonography were enrolled in this retrospective chart review. Results: The incidence of DDH was 6.45% (10 of 155). Gestational age, birth weight, sex ratio, and breech presentation did not differ significantly between infants treated for DDH (n=10) and nontreated infants (n=145) (gestational age, 29.2±1.4 weeks vs. 29.6±2.0 weeks, P=0.583; birth weight, 1,240±237 g vs. 1,295±335 g, P=0.607; female sex, 7 of 10 (70.0%) vs. 77 of 145 (53.1%), P=0.346; and breech presentation, 5 of 10 (50.0%) vs. 43 of 145 (29.7%), P=0.286, respectively). Performing the first ultrasonography earlier than 38 weeks of postmenstrual age (PMA) increased the risk of an abnormal finding by 3.76 times compared to performing it at ≥38 weeks of PMA. These abnormal findings on ultrasonography resolved spontaneously. Breech presentation increased the risk of minor abnormal findings on the first ultrasonography by 3.11 times versus nonbreech presentation and resolved spontaneously. DDH in preterm infants did not occur predominantly on the left side or in infants born with breech presentation. Conclusion: Performing ultrasonography screening earlier than 38 weeks of PMA caused unnecessary subsequent ultrasonography and overtreatment. Breech presentation was not a risk factor for DDH in preterm infants. However, breech presentation could increase the risk of minor abnormal findings at the 1st ultrasonography compared to nonbreech presentation, which resolved spontaneously. The etiology and risk factors for DDH in preterm infants are somewhat different from those for DDH in term infants.

Keywords

References

  1. Storer SK, Skaggs DL. Developmental dysplasia of the hip. Am Fam Physician 2006;74:1310-6.
  2. Lange AE, Lange J, Ittermann T, Napp M, Krueger PC, Bahlmann H, et al. Population-based study of the incidence of congenital hip dysplasia in preterm infants from the Survey of Neonates in Pomerania (SNiP). BMC Pediatr 2017;17:78. https://doi.org/10.1186/s12887-017-0829-5
  3. Shaw BA, Segal LS. Evaluation and referral for developmental dysplasia of the hip in infants. Pediatrics 2016;138:e20163107. https://doi.org/10.1542/peds.2016-3107
  4. Yang S, Zusman N, Lieberman E, Goldstein RY. Developmental dysplasia of the hip. Pediatrics 2019;143:e20181147. https://doi.org/10.1542/peds.2018-1147
  5. Ortiz-Neira CL, Paolucci EO, Donnon T. A meta-analysis of common risk factors associated with the diagnosis of developmental dysplasia of the hip in newborns. Eur J Radiol 2012;81:e344-51. https://doi.org/10.1016/j.ejrad.2011.11.003
  6. Clinical practice guideline: early detection of developmental dysplasia of the hip. Committee on Quality Improvement, Subcommittee on Developmental Dysplasia of the Hip. American Academy of Pediatrics. Pediatrics 2000;105(4 Pt 1):896-905. https://doi.org/10.1542/peds.105.4.896
  7. Kolb A, Schweiger N, Mailath-Pokorny M, Kaider A, Hobusch G, Chiari C, et al. Low incidence of early developmental dysplasia of the hip in universal ultrasonographic screening of newborns: analysis and evaluation of risk factors. Int Orthop 2016;40:123-7. https://doi.org/10.1007/s00264-015-2799-2
  8. Sewell MD, Rosendahl K, Eastwood DM. Developmental dysplasia of the hip. BMJ 2009;339:b4454. https://doi.org/10.1136/bmj.b4454
  9. Duramaz A, Duramaz BB, Bilgili MG. Does gestational age affect ultrasonographic findings of the hip in preterm newborns? A sonographic study of the early neonatal period. J Pediatr Orthop B 2019;28:107-10. https://doi.org/10.1097/BPB.0000000000000541
  10. Tuncay IC, Karaeminogullari O, Demirors H, Tandogan NR. Is prematurity important in ultrasonographic hip typing? J Pediatr Orthop B 2005;14:168-71. https://doi.org/10.1097/01202412-200505000-00005
  11. Dogruel H, Atalar H, Yavuz OY, Sayli U. Clinical examination versus ultrasonography in detecting developmental dysplasia of the hip. Int Orthop 2008;32:415-9. https://doi.org/10.1007/s00264-007-0333-x
  12. Lee J, Spinazzola RM, Kohn N, Perrin M, Milanaik RL. Sonographic screening for developmental dysplasia of the hip in preterm breech infants: do current guidelines address the specific needs of premature infants? J Perinatol 2016;36:552-6. https://doi.org/10.1038/jp.2016.7
  13. Graf R. New possibilities for the diagnosis of congenital hip joint dislocation by ultrasonography. J Pediatr Orthop 1983;3:354-9. https://doi.org/10.1097/01241398-198307000-00015
  14. Omeroglu H. Use of ultrasonography in developmental dysplasia of the hip. J Child Orthop 2014;8:105-13. https://doi.org/10.1007/s11832-014-0561-8
  15. Kang YR, Koo J. Ultrasonography of the pediatric hip and spine. Ultrasonography 2017;36:239-51. https://doi.org/10.14366/usg.16051
  16. Brusalis CM, Price CT, Sankar WN. Incidence of acetabular dysplasia in breech infants following initially normal ultrasound: the effect of variable diagnostic criteria. J Child Orthop 2017;11:272-6. https://doi.org/10.1302/1863-2548.11.160261
  17. Imrie M, Scott V, Stearns P, Bastrom T, Mubarak SJ. Is ultrasound screening for DDH in babies born breech sufficient? J Child Orthop 2010;4:3-8. https://doi.org/10.1007/s11832-009-0217-2
  18. Hegde D, Powers N, Nathan EA, Rakshasbhuvankar AA. Developmental dysplasia of the hip in preterm breech infants. Arch Dis Child Fetal Neonatal Ed 2020;105:556-8. https://doi.org/10.1136/archdischild-2019-317658
  19. Quan T, Kent AL, Carlisle H. Breech preterm infants are at risk of developmental dysplasia of the hip. J Paediatr Child Health 2013;49:658-63. https://doi.org/10.1111/jpc.12250
  20. D'Alessandro M, Dow K. Investigating the need for routine ultrasound screening to detect developmental dysplasia of the hip in infants born with breech presentation. Paediatr Child Health 2019;24:e88-93. https://doi.org/10.1093/pch/pxy081
  21. Hussain SM, Ackerman IN, Wang Y, Zomer E, Cicuttini FM. Could low birth weight and preterm birth be associated with significant burden of hip osteoarthritis? A systematic review. Arthritis Res Ther 2018;20:121. https://doi.org/10.1186/s13075-018-1627-7
  22. Orak MM, Onay T, Gumustas SA, Gursoy T, Muratli HH. Is prematurity a risk factor for developmental dysplasia of the hip? : a prospective study. Bone Joint J 2015;97-B:716-20. https://doi.org/10.1302/0301-620X.97B5.34010
  23. Roovers EA, Boere-Boonekamp MM, Castelein RM, Zielhuis GA, Kerkhoff TH. Effectiveness of ultrasound screening for developmental dysplasia of the hip. Arch Dis Child Fetal Neonatal Ed 2005;90:F25-30. https://doi.org/10.1136/adc.2003.029496
  24. AIUM practice guideline for the performance of an ultrasound examination for detection and assessment of developmental dysplasia of the hip. J Ultrasound Med 2013;32:1307-17. https://doi.org/10.7863/ultra.32.7.1307
  25. AIUM-ACR-SPR-SRU Practice parameter for the performance of an ultrasound examination for detection and assessment of developmental dysplasia of the hip. J Ultrasound Med 2018;37:E1-5. https://doi.org/10.1002/jum.14829