Ultrasound screening of high-risk infants. A method to increase early detection of congenital dysplasia of the hip
R. S. Walter, J. S. Donaldson, C. L. Davis, A. Shkolnik, H. J. Binns, N. C. Carroll and R. T. Brouillette
Department of Pediatrics, A. I. duPont Institute, Division of General Pediatrics, Wilmington, Del; 19899.
Congenital dysplasia of the hip (CDH) continues to be missed by routine
physical screening examinations in the early months when treatment is most
effective. Real-time ultrasonography (US) is valuable in the detection of
CDH in the young infant. We performed a prospective study to evaluate one
US screening strategy that targets a select "high-risk newborn" population
at risk for CDH aiming to increase the early diagnosis of this condition.
From 1772 consecutive births at one hospital, we identified 97 (5.5%)
newborns with risk factors for CDH: breech delivery, 73 babies; family
history, 26 babies; postural abnormalities, five babies; and
oligohydramnios, four babies. Eleven newborns had two risk factors. We
studied 69 of these newborns with US. There were four cases of CDH in this
group. Three of these babies had completely normal pediatric physical
examination results at the time of the US study (at 14, 75, and 100 days,
respectively) despite dysplasia diagnosed by US. All were successfully
treated with a harness as outpatients. We conclude that a screening program
entailing identification and subsequent US of the hip of newborns with
specific physical and historical risk factors for CDH increases early
diagnosis. Further analysis suggests this approach is cost-effective.
