Surveillance for Developmental Dysplasia of the Hip in India: Consensus Guidelines From the Pediatric Orthopaedic Society of India, Indian Academy of Pediatrics, National Neonatology Forum of India, Indian Radiological and Imaging Association, Indian Federation of Ultrasound in Medicine and Biology, Federation of Obstetric and Gynaecological Societies of India, and Indian Orthopaedic Association

Aroojis, Alaric; Anne, Rajendra Prasad; Li, Jacqueline; Schaeffer, Emily K.; Kesavan, TM; Shah, Samir S.; Patwardhan, Sandeep; Karnik, Alka; Thanawala, Uday

doi:10.1007/s13312-022-2577-3

Cited by 7 publications

(14 citation statements)

References 37 publications

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“…In certain situations, when the clinician believes that the baby is at risk for loss to follow-up, an ultrasound can be done right away even earlier. 3,4 A cross-sectional study from Riyadh city in Saudi Arabia 7 assessed the level of DDH knowledge among 340 parents. Only 68% parents had prior knowledge about DDH and 32% had no idea at all about this condition.…”

Section: Resultsmentioning

confidence: 99%

“…The incidence of hip dysplasia in India is reported to be 0 to 75/1,000 live births, with incidence of true DDH between 0 to 2.6/1,000 live births. [1][2][3] Exact etiology for DDH remains elusive. However, certain risk factors for DDH have been identified.…”

Section: Introductionmentioning

confidence: 99%

“…An association of DDH has been described with congenital muscular torticollis, metatarsus adductus, and talipes equinovarus. [1][2][3] All neonates must be screened at birth for DDH by a clinical examination followed by continued surveillance for DDH till 18 months of age. 3,4 When the DDH is diagnosed and treated well in time during infancy, conservative management is often successful with good long-term outcomes.…”

Section: Introductionmentioning

confidence: 99%

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

Prasad,

Gupta,

Parashar

et al. 2023

Journal of Neonatology

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Prasad,

Gupta,

Parashar

et al. 2023

Journal of Neonatology

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“…A SpO 2 ≤ 89% in either of the limbs defines a Notes: Based on Indian guidelines on surveillance for DDH. 23 Routine Hip Surveillance refers to hip examinations during well-baby checks/immunization visits at the approximate time points of 6 weeks, 10 weeks, 14 weeks, 6 months, 9 months, 12 months, 15 months, and 18 months of age. failed test and warrants further evaluation.…”

Section: Congenital Heart Diseasementioning

confidence: 99%

Newborn Screening: A Practical Guide to Pediatricians and Neonatologists

Anne,

Rahiman,

Bharti

2023

Journal of Neonatology

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Newborn screening, while universal in most high- and middle-income countries, is still in its nascent stages in India. It is estimated that only <3% of neonates born in India in 2021 were screened for disorders. The disorders that can be picked up early by newborn screening range across endocrine, metabolic, cardiac, hematological, visual, and auditory defects. The burden of disorders is higher in India than in the global estimates. As a result, many neonates with easily treatable disorders are being missed in the neonatal period, resulting in increased morbidity and mortality. Worldwide, studies have shown that universal newborn screening is feasible and cost effective. As India does not have a national policy and/or program existent on newborn screening, pediatricians and obstetricians have an important role to play to improve the newborn screening rates in India. Moreover, the screening needs to be comprehensive, extending beyond some limited blood tests, so that the neonates will be maximally benefited. With this background, we have provided a brief overview of newborn screening for practicing pediatricians and neonatologists. The purpose of this article is to help pediatricians and neonatologists to initiate newborn screening in their units.

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“…The variation in the reported incidence of DDH among different populations leads to the lack of consensus regarding the treatment protocol for this condition. Many authors suggest implemetning a protocol that includes clinical and ultrasonography examinations for DDH in high-risk individuals (5,6,7). Because of the high incidence of DDH in our country, a combined protocol that includes universal mandatory physical examination and ultrasound hip screening up to 8 weeks of age has been accepted.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of ultrasound-monitored treatment of divelopmental dysplasia of the hip graf type II

Djoleva¹,

Matveeva²,

Georgieva³

et al. 2022

Sanamed

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Introduction: The management of developmental dysplasia of the hips (DDH) type Graf IIa is still controversial. This study aims to examine the outcomes of ultrasound-monitored Pavlik harness treatment, as well as the effects of associated factors, such as gender, side of DDH, the age at the treatment start, and laterality on the treatment outcomes in different Graf type II subtypes. Methods: A cohort retrospective investigation was performed on 88 ultrasound-screened infants or 125 hips diagnosed with Graf type II dysplasia during a six-month period at a single institution, the University Clinic for Orthopedic Surgery, Skopje. Subsequently, 47 infants (18 boys, 29 girls) or 73 hips who underwent Pavlik harness treatment with at least one follow-up throughout treatment monitoring were included in this study. Results: The treatment success rate of the right DDH Graf type IIa (-) was higher (70.8%) compared to the rate of success (50%) in the treatment of left Graf type IIa (-) hips. The mean age of the infants at the treatment start in successfully treated Graf type IIa (-) hips was lower (9.12 ±2.27 weeks) compared to the age of the infants with treatment failure at the last follow-up (11.33 ±3.06 weeks), P= 0.04.

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Cited by 7 publications

References 37 publications

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

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

Newborn Screening: A Practical Guide to Pediatricians and Neonatologists

Outcomes of ultrasound-monitored treatment of divelopmental dysplasia of the hip graf type II

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