Newborn Screening for Developmental Dysplasia of Hip—A Survey for Knowledge and Skills Among Physicians in Delhi-NCR Region, India

Abstract

Introduction Developmental dysplasia of hip (DDH) is a developmental disorder leading to life-long disability in child unless diagnosed early and treated well in time. This condition is also included under the screening and early intervention services provided by “Rashtriya Bal Swasthya Karyakram” of National Health Mission in India. The present study was done to assess knowledge, perceptions, and self-confidence of pediatricians/neonatologists, obstetricians, primary care physicians (PCPs), and the orthopedic surgeons regarding the newborn screening for DDH. Materials and Methods This cross-sectional study used a prestructured validated online questionnaire in English language. Total 158 physicians, practicing in various private and government, teaching, and nonteaching institutions from Delhi-NCR region (54 pediatrician/neonatologists, 60 PCPs, 30 orthopedic surgeons, and 14 obstetricians), responded to the survey. Questions related to biodemographic details, specialty, professional experience, knowledge about the risk factors of DDH, appropriate timing(s) for screening DDH and the modalities used, and natural course of untreated severe and mild DDH were asked. Participants were required to self-assign a grade (score 0-10) for both knowledge and clinical examination skills with reference to screening of DDH. Data was analyzed using SPSS (version 23.0) software. P value <0.05 was considered significant. Results Only 18% pediatricians, 27% PCPs, 20% orthopedic surgeons, and none of the obstetrician could identify all risk factors for DDH ( P = 0.159). Only 24% physicians knew that the natural evolution of untreated severe DDH is bad with need for multiple surgeries throughout life and only 17% knew that the most common natural evolution of untreated mild hip dysplasia at birth is good with minimal functional sequelae without the need for surgery. Only 56% pediatricians mentioned correctly that the first screening for DDH needs to be done at birth before discharge from the hospital. Orthopedic surgeons, obstetricians, and PCPs were comparable to pediatricians in this knowledge ( P ≥ 0.05). Only 52% pediatricians were aware of both Barlow and Ortolani clinical maneuvers and 18% did not know about any of these tests. Among orthopedic surgeons, 60% knew about both these tests and among obstetricians, only 14% knew about both these tests. Self-assigned score for both knowledge and clinical examination skills were unsatisfactory in all groups, the range of median score being 5 to 7 and 2 to 6, respectively. Clinical examination skills scores were significantly lower among obstetricians than the other groups ( P = 0.001; Kruskal-Wallis test). Clinical examination skills scores were significantly lower than the knowledge scores among PCPs, orthopedic surgeons, and obstetricians ( P = 0.001, 0.026, and 0.005, respectively; Wilcoxon Signed-Rank test). Conclusion Knowledge was unsatisfactory among all physicians, regardless of their specialty. Self-assigned scores for clinical examination skills, which is a surrogate of self-confidence and likely to affect the practices, were also unsatisfactory among all physicians, regardless of their specialty. The findings of this study indicate an immediate need of attention for continuing education and handholding of all stakeholders who are directly responsible for screening and early diagnosis of DDH at birth and early infancy. Such a pertinent issue should be incorporated as a core knowledge as well as skill competencies in both undergraduate and postgraduate medical education curriculum.