Neonatal Screening for Hip Instability: Five Years' Experience

Abstract

All newborn infants delivered at King Fahd Hospital of the University in Al-Khobar between June 1982 and May 1987 were subjected to routine physical examinations, including the Ortolani and Barlow maneuvers for detection of hip instability. A total of 12,733 neonates were screened, and a positive test was found in 62 (0.49%). Infants with a positive test were placed in a von Rosen splint for 6 to 8 weeks. Five "missed" cases were diagnosed later, all of whom were born during the first year of the study. Male-to-female ratio was 1:4.2. Bilateral hip instability was seen more commonly in males than females. Known factors that increase the risk of hip instability include breech presentation and large weight for gestation. Follow-up was possible in 47 patients; all were asymptomatic except for one with poor compliance who required further surgical intervention. The importance of neonatal screening and continued follow-up for detection of hip instability among all hospital-delivered babies is stressed to prevent the hazards of late diagnosis.

Congenital Hip Instability in Hospital Born Neonates in Abha

“…The female predominance is in keeping with other reports from the Middle East and the West [3,10]. The proportion of bilateral instability and left laterality are similar to Western figures [12] and at variance with Mufti's [13] data from Riyadh as shown in Table 5.…”

“…This is comparable to the incidence found in some communities such as the Lapps, American Indians, and the Japanese in the early sixties [2,7]. Al-Umranet al [3] reported a lower incidence (0.49%) with congenital hip instability in a hospital born cohort over a five-year period from the Eastern Province of Saudi Arabia. This suggests a true regional variation in the incidence of hip instability within the country.…”

“…There are geographical and racial variations in the incidence and severity of congenital hip instability [2] and this may cause varying demands on the health care system. Reports on the extent of the problem in Saudi Arabia are limited and show a wide variation [3][4][5]. Despite improvements in the health care system in the Kingdom of Saudi Arabia, the lack of adequate neonatal screening in various areas in the Kingdom continues to result in considerable hip related morbidity in later childhood.…”

Neonatal Hip Instability in Saudi Arabia: Results And Cost Effectiveness

“…No case of femoral head necrosis was observed using the von Rosen splint. 1 It is suggested that three to five babies may be splinted unnecessarily for every one benefiting from the procedure. 2,15 Yet considering: a) the serious long-term morbidity in overlooked cases; b) the poor results of late intervention; and c) the lack of complications and minor inconvenience of the splintage, it may be argued that the screening and management program should continue.…”

“…Experiences in the Eastern Province of Saudi Arabia are evidence in point. 1,2 The benefits of screening are substantial and very few cases are overlooked at birth if a sustained screening program is in operation. 3 Routine screening of all neonates at the King Fahd Hospital of the University (KFHU) began in 1982G, with the necessary cooperation between the Departments of Pediatrics and Orthopedics in the diagnosis and management of neonates with unstable hips.…”