Newborn Screening and Prevention

The United States Preventive Services Task Force has concluded that “evidence is insufficient to recommend routine screening for developmental dysplasia of the hip (DDH) in infants”. (Pediatrics 117:898-902, 2006)  However, the absence of evidence does not mean that screening has no value. It probably means that we have not scientifically proven the value of screening to the satisfaction of statisticians and public health officials.

Universal screening of all newborns with hip ultrasound is not generally recommended by the medical community, but screening of all newborn infants with a physical examination followed by appropriate use of hip ultrasound is widely accepted. (Schwend, et.al. J. Pediatr. Orthop. 27:607010, 2007) Scientific publications by IHDI physicians have demonstrated the cost-effectiveness and clinical effectiveness of this combined approach (JBJS 91A:1705, 2009; Acta Paediatr. 90:836, 2001; JBJS 76B:525, 1994).


Recent developments in Ultrasound Diagnostics in relation to Breech Births:
Ultrasound is suggested for:

  • 2 to 6 week old infant with questionable examination, especially first-born girls
  • 6 week-old with family history of hip dysplasia even when the exam is normal
  • 6 week-old girl who was in the breech position even when the exam is normal
  • Consider an ultrasound for 6 week-old boys who were in breech position even when the exam is normal

American Academy of Pediatrics (AAP) has guidelines for detection of hip dysplasia. These screening guidelines are dependent on the use of history, physical exam, and imaging.  AAP recommends all newborns should be examined at birth for developmental dysplasia of the hip.  If the exam shows instability, then referral or treatment is recommended. The hip examination is repeated at 2-4 weeks of age. An ultrasound study or referral to orthopedics is recommended when that examination is suspicious for hip dysplasia. When the hip examination is normal, then risk factors are considered. Some of the most important risk factors are positive family history of hip dysplasia and breech position in the womb. The AAP suggests that an ultrasound study at six weeks of age or an x-ray of the pelvis at 4 months of age is warranted when there is a positive family history of hip dysplasia and also for girls who were in the breech position. Even boys have a high risk for dysplasia after breech birth so imaging studies may be useful for those infants too. A recent study out of Rady Children’s hospital in San Diego questions whether the current screening practices are sufficient for babies who were in the breech position.  They found that 29% of breech babies with a normal ultrasound at six weeks developed mild hip dysplasia by 4-6 months of age. The study recommended that all breech birth babies have an X-ray of the pelvis at six months of age as a possible method to reduce the risk of developing late DDH in this group of patients..

References:
1. Imrie, Meghan, Scott, Vanessa, Stearns, Philip., “Is ultrasound screening for DDH in babies born breech sufficient?”  Journal of  Child Orthopedics (2010) 4:3-8
2. Committee on Quality Improvement, Subcommittee on Developmental Dysplasia of the hip,. American Academy of Pediatrics (2000) Clinical practice guideline: early detection of developmental dysplasia of the hip. Pediatrics 105: 896-905

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