Diagnosing newborns in the UK

“Newborn Hip Checks Have Failed to Prevent Late Diagnosis”

This was a recent headline on BBC News in England. https://www.bbc.com/news/health-47735103 A research paper published by an IHDI Physician showed that the rate of late diagnosis has not changed in 35 years. This is in spite of a national health service and wide use of ultrasound for babies at higher risk for hip dysplasia; such as families with positive family history or breech births. During the period of the study approximately 30 children per year weren’t diagnosed until after the age of one year. That doesn’t count the children detected after six weeks of age when treatment is only half as successful as hip dislocations found before six weeks of age. An IHDI study published in 2016 showed one in four children with a dislocated hip wasn’t diagnosed until after the age of six weeks.

This recent report from England emphasizes that current methods of early diagnosis have clearly failed. Physical exam of the newborn, even by experienced physicians, is not as reliable as once thought. Professor Ortolani described the technique for newborn examination in 1948 and many pediatricians have learned to perform this examination skillfully. However, in Professor Ortolani’s book he stated that only mild hip dislocations that can be placed back into the socket can be detected. He specifically noted that the dislocation signs, “…in serious cases, they are seldom noticeable”. This is because the hip is trapped outside the socket so there is no sensation of the hip going into and out of the socket.

It is clear that improved methods of diagnosis are needed. Comprehensive ultrasound studies are expensive and time consuming to perform for every infant. However, IHDI is investigating newer technological advances that may assist the examiner by “listening” to the sounds of a normal or abnormal hip, or by using simpler ultrasound methods at the bedside with an APP for a hand-held mobile device.

You can help by supporting development of new technology and by being aware that all hip dislocations cannot be detected by physical examination alone.

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