An audit of referral time frames for ultrasound screening of developmental hip dysplasia in neonates with a normal antenatal clinical examination

Abstract

Introduction: Ultrasound has an established role in the detection of developmental dysplasia of the hip (DDH). Lack of uniformity in the appropriate age to perform studies in at-risk children with a normal clinical examination at birth exists. Opening a new tertiary paediatric hospital saw a variety of referral time frames for initial screening ultrasound for DDH.Methods: Literature review and retrospective clinical audit were undertaken. DDH ultrasounds of babies with the following criteria were reviewed: normal clinical examination and one or more risk factors. Patients were followed up via their electronic medical record.Results: There were 187 eligible patients: 124 (66.3%) had normal initial scans while 63 (33.7%) were recommended to have a follow-up scan. Most subnormal results (Graf 2A or lower, laxity and/or less than 50% femoral head coverage) (n = 59, 93.7%) were scanned before 6 weeks of age, only four (6.3%) presented at 5 weeks after birth or later.Discussion: This study identified a potential for reduction in follow-up studies through delayed initial ultrasound, improving from 4 to 6 weeks of age, without adverse outcomes. Early screening ultrasounds may result in overdiagnosis of DDH during the maturation process of the neonatal acetabulum, potentially causing anxiety and unnecessary follow-up.

The application of artificial intelligence in the sonography profession: Professional and educational considerations

“…These examinations are performed either by orthopaedic surgeons or by sonographers using strict technical parameters to ensure consistency. However, they can still lead to over-diagnosis and over-treatment, [36][37][38] and there is some debate about when and how best to perform screening or surveillance for the condition. 39 AI has been demonstrated to accurately analyse US 3D datasets of infant hips and predict the likelihood and severity of DDH, 40 removing much of the operator variability from the examination.…”

Parents’ expectations and experiences of the 6-week baby check: a qualitative study in primary care

“…1 They specify all eligible babies will be offered an examination within 72 hours of birth and at 6–8 weeks of age (the 6-week check), given that some abnormalities not easily detected in newborns can become more apparent by this age. 2 , 3 The 6-week check is done in primary care, typically by GPs. Guidance advises GPs to include the baby’s height, weight, head circumference, general tone and posture, lungs, and general wellbeing, and to provide a range of general health promotion advice, covering topics as diverse as car safety, breastfeeding, and smoking.…”