Neonatal hip screening

Abstract

Deborah Eastwood (Feb 15, p 595)1Eastwood DM Neonatal hip screeing.Lancet. 2003; 361: 595-597Summary Full Text Full Text PDF PubMed Scopus (69) Google Scholar is right to state that a missed case of congenital dislocation of the hip (CDH) can be disaster for the patient and family and that, since good results may be achieved by neonatal screening, we should concentrate on extending effective practice rather than debating whether or not screening is worthwhile. Eastwood draws attention to the excellent results obtained by the ultrasonography screening programme in Coventry.2Marks DS Clegg J Al-Chababi AN Routine ultrasound screening for neonatal hip instability: can it abolish late-presenting congenital dislocation of the hip?.J Bone Joint Surg. 1994; 76B: 534-538Google Scholar Similarly good results have, of course, also been obtained by many clinical screening programmes in the past. In a population study in Australia, P Goss3Goss PW Successful screening for neonatal hip instability in Australia.J Paediatr Child Health. 2002; 38: 469-474Crossref PubMed Scopus (16) Google Scholar found that there were no late diagnosed cases of CDH in a screened population during 12 years. Although a small study, it was closely supervised. On the basis of my own experience of clinical and ultrasonography screening,4Dunn PM Congenital dislocation of the hip: screening, diagnosis and management.in: Koppe JG Eskes TKAB Care, concern and cure in perinatal medicine. The Parthenon Publishing Company, Carnforth1993: 297-309Google Scholar I favour the use of primary clinical screening of all babies, supported, as appropriate, by dynamic ultrasonography, selective screening, or both. But for any programme to be effective there must be leadership and multidisciplinary collaboration; those undertaking the Ortolani/Barlow manoeuvre or ultrasonography must be trained, skilled, and supervised, and there has to be continuous audit of the screening process, the follow-up (2 years), and the outcome. Clinical screening should be undertaken within 24 h of birth to avoid false-negative results from temporary stabilisation of an unstable hip after birth.5Standing Medical Advisory Committee Standing Nursing and Midwifery Advisory Committee Screening for the detection of congenital dislocation of the hip. Department of Health and Social Security, London1986Google Scholar Primary clinical screening makes economic and practical sense. 98% of babies in the UK are born in maternity units, nearly all of which have paediatric staffing. All babies should be fully examined by skilled staff as soon after birth as possible, and this examination is especially important with the increasing early return home of many mothers. Clinical screening requires no apparatus and may be readily taught with the aid of a manikin.5Standing Medical Advisory Committee Standing Nursing and Midwifery Advisory Committee Screening for the detection of congenital dislocation of the hip. Department of Health and Social Security, London1986Google Scholar On the other hand, dynamic ultrasonography screening requires equipment and the sono-grapher's expertise. Furthermore, poor discrimination within the first few days of life usually necessitates a special visit to the clinic after a mother has been discharged from hospital. All these factors add to the expense.