Ultrasound examination to detect developmental dysplasia of the hip in newborn infants

For decades, all newborn infants have been examined by a paediatrician within days after being born. As part of this routine screening of all newborns the hips are being examined for potential developmental dysplasia. In Sweden there is variation in practice regarding which newborns, that in addition to the routine clinical examination, also are examined by ultrasound to detect potential developmental dysplasia of the hips (DDH).

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202031 Registration no: SBU 2019/670

Question

What systematic reviews are there on ultrasound examination, in addition to routine clinical examination, of newborn infants to detect potential developmental dysplasia of the hips (DDH)?

Identified literature

Table 1 Systematic reviews with low/medium risk of bias.

US = ultrasound examination; DDH = developmental dysplasia of the hip
* all infants received US; ** US examination is performed on a subset of infants (usually defined by risk of DDH, e.g. family history of DDH or female breech birth)
Included studies Population/Intervention Outcome
Shorter et al 2011 [1]
5 studies:
2 studies compared either clinical examination or targeted US or universal US as initial screening for DDH.
3 studies compared different examination and treatment strategies out of scope of the question answered by SBU Enquiry Service		 Types of infants:
All newborn infants (up to 6 weeks of age) being screened for DDH.

Types of interventions:
Combinations (13) of different types of examination strategies for DDH:
  • clinical examination
  • universal* US examination
  • targeted** US examination
  • no examination by any method
 Incidence of late diagnosed DDH (> 8 weeks of age, diagnosed by either clinical examination, ultrasound, or x-ray), for which either medical och surgical intervention is needed.
Authors' conclusion:
“There is insufficient evidence to give clear recommendations for practice. There is inconsistent evidence that universal ultrasound results in a significant increase in treatment compared to the use of targeted ultrasound or clinical examination alone. Neither of the ultrasound strategies have been demonstrated to improve clinical outcomes including late diagnosed DDH and surgery. The studies are substantially underpowered to detect significant differences in the uncommon event of late detected DDH or surgery.”

In addition, 17 primary studies were identified [2–18]. The primary studies were not assessed for risk of bias

References

  1. Shorter D, Hong T, Osborn DA. Screening programmes for developmental dysplasia of the hip in newborn infants. The Cochrane database of systematic reviews 2011;2011:CD004595-CD004595.
  2. Afaq AA, Stokes S, Fareed H, Zadeh HG, Watson M. Ultrasound in the selective screening of developmental dysplasia of the hip. European review for medical and pharmacological sciences 2011;15:394-398.
  3. Tong SHY, Eid MAM, Chow W, To MKT. Screening for developmental dysplasia of the hip in Hong Kong. Journal of orthopaedic surgery (Hong Kong) 2011;19:200-203.
  4. Tschauner C, Fürntrath F, Saba Y, Berghold A, Radl R. Developmental dysplasia of the hip: impact of sonographic newborn hip screening on the outcome of early treated decentered hip joints-a single center retrospective comparative cohort study based on Graf's method of hip ultrasonography. Journal of children's orthopaedics 2011;5:415-424.
  5. Clarke NMP, Reading IC, Corbin C, Taylor CC, Bochmann T. Twenty years experience of selective secondary ultrasound screening for congenital dislocation of the hip. Archives of disease in childhood 2012;97:423-429.
  6. von Kries R, Ihme N, Altenhofen L, Niethard FU, Krauspe R, Rückinger S. General ultrasound screening reduces the rate of first operative procedures for developmental dysplasia of the hip: a case-control study. The Journal of pediatrics 2012;160:271-275.
  7. Barr LV, Rehm A. Should all twins and multiple births undergo ultrasound examination for developmental dysplasia of the hip?: A retrospective study of 990 multiple births. The bone & joint journal 2013 Jan;95:132-134.
  8. Price KR, Dove R, Hunter JB. Current screening recommendations for developmental dysplasia of the hip may lead to an increase in open reduction. The bone & joint journal 2013 Jun;95:846-850.
  9. Laborie LB, Engesæter I, Lehmann TG, Eastwood DM, Engesæter LB, Rosendahl K. Screening strategies for hip dysplasia: long-term outcome of a randomized controlled trial. Pediatrics 2013 June;132:492‐501.
  10. Laborie LB, Markestad TJ, Davidsen H, Brurås KR, Aukland SM, Bjørlykke JA, et al. Selective ultrasound screening for developmental hip dysplasia: effect on management and late detected cases. A prospective survey during 1991-2006. Pediatric radiology 2014;44:410-424.
  11. Donnelly KJ, Chan KW, Cosgrove AP. Delayed diagnosis of developmental dysplasia of the hip in Northern Ireland: Can we do better? Bone and Joint Journal 2015;97:1572-1576.
  12. Mace J, Paton RW. Neonatal clinical screening of the hip in the diagnosis of developmental dysplasia of the hip: a 15-year prospective longitudinal observational study. The bone & joint journal 2015;97:265-269.
  13. Tyagi R, Zgoda MR, Short R. Targeted Screening of Hip Dysplasia in Newborns: Experience at a District General Hospital in Scotland. Orthopedic reviews 2016;8:6640-6640.
  14. Talbot C, Adam J, Paton R. Late presentation of developmental dysplasia of the hip : a 15-year observational study. The bone & joint journal 2017;99:1250-1255.
  15. Choudry QA, Paton RW. Neonatal screening and selective sonographic imaging in the diagnosis of developmental dysplasia of the hip. The bone & joint journal 2018;100:806-810.
  16. Olsen SF, Blom HC, Rosendahl K. Introducing universal ultrasound screening for developmental dysplasia of the hip doubled the treatment rate. Acta paediatrica (Oslo, Norway : 1992) 2018;107:255-261.
  17. Westacott DJ, Butler D, Shears E, Cooke SJ, Gaffey A. Universal versus selective ultrasound screening for developmental dysplasia of the hip: a single-centre retrospective cohort study. Journal of pediatric orthopedics. Part B 2018;27:387-390.
  18. Gyurkovits Z, Sohár G, Baricsa A, Németh G, Orvos H, Dubs B. Early detection of developmental dysplasia of hip by ultrasound. Hip international : the journal of clinical and experimental research on hip pathology and therapy 2019:1120700019879687-1120700019879687.

Literature search

PubMed via NLM 2020-04-15 
Screening for Developmental Dysplasia of the Hip in Newborn Infants
The search result, usually found at the end of the documentation, forms the list of abstracts; [MeSH Terms] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; [Title/Abstract] = Title or abstract; * = Truncation
Search terms Items found
Population:
1. "infant, newborn"[MeSH Terms] OR "infant*"[Title/Abstract] OR "newborn*"[Title/Abstract] OR "neonate*"[Title/Abstract] 920 928
2. "hip dislocation, congenital"[MeSH Terms] OR "hip dislocation"[Title/Abstract] OR "developmental dysplasia of the hip"[Title/Abstract] OR "hip dysplasia"[Title/Abstract] OR "dysplasia of the hip"[Title/Abstract] OR "DDH"[Title/Abstract] 12 715
3. 1 AND 2 2 989
Intervention:
4. "neonatal screening"[MeSH Terms] OR "mass screening"[MeSH Terms] OR "screening"[Title/Abstract] 562 219
5. "ultrasonography"[MeSH Terms] OR "ultraso*"[Title/Abstract] OR "sonogra*"[Title/Abstract] 629
6. 4 AND 5 25 389
Final 3 AND 6 539

 

Cochrane Library via Wiley 2020-04-15 
Screening for Developmental Dysplasia of the Hip in Newborn Infants
The search result, usually found at the end of the documentation, forms the list of abstracts; MeSH = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; :ti = Title; :ab = Abstract; :kw = Keyword; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. MeSH descriptor: [Infant, Newborn] explode all trees 15 495
2. infant* OR newborn* OR neonate*:ti,ab,kw 67 476
3. 1 OR 2 67 476
4. MeSH descriptor: [Hip Dislocation, Congenital] explode all trees 87
5. "hip dislocation" OR "developmental dysplasia of the hip" OR "hip dysplasia" OR "dysplasia of the hip" OR "DDH":ti,ab,kw 372
6. 4 OR 5 372
7. 3 AND 6 67
Intervention:
8. MeSH descriptor: [Neonatal Screening] explode all trees 126
9. MeSH descriptor: [Mass Screening] explode all trees 3 639
10. screening:ti,ab,kw 51 378
11. 8 OR 9 OR 10 51 736
Final 7 AND 11

Cochrane reviews: 1
Cochrane protocols: 0
Trials: 22
Editorials: 0
Special collections: 0
Clinical answers: 0		 23

 

Embase via embase.com 2020-04-15 
Screening for Developmental Dysplasia of the Hip in Newborn Infants
/de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; :ti,ab,kw = Title or abstract or keywords; * = Truncation; ’ ’ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. 'newborn'/exp 592 739
2. infant* OR newborn* OR neonate*:ti,ab,kw 1 468 644
3. 1 OR 2 1 468 644
4. 'congenital hip dislocation'/exp 5 731
5. 'hip dislocation' OR 'developmental dysplasia of the hip' OR 'hip dysplasia' OR 'dysplasia of the hip' OR 'ddh':ti,ab,kw 21 447
6. #4 OR #5 21 447
7. 3 AND 6 5 059
Intervention:
8. 'newborn screening'/exp 18 609
9. 'mass screening'/exp 242 630
10. screening:ti,ab,kw 734 602
11. 8 OR 9 OR 10 841 002
Combined sets:
12. #7 AND #11 955
Limits:
13. [embase]/lim  
Final 12 AND 13 715
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