Developmental Dysplasia of the Hip Is Not Associated with Breech Presentation in Preterm Infants

Abstract

Objectives The aim of the study is to (1) determine the incidence of developmental dysplasia of the hip (DDH) in preterm infants born prior to 35 completed weeks' gestation in a breech presentation, and (2) evaluate if the association between breech presentation and DDH in full-term infants holds for premature infants.

Study Design This study design comprises retrospective review of infants born between January 1, 2008, and December 31, 2017, at <35 weeks' gestation and admitted to the NICU. Infants had hip ultrasounds at 4 to 6 weeks' corrected age if they were born in a breech presentation with a stable hip examination. We excluded infants born in a presentation other than breech or vertex, had no documentation of presentation at birth, or if they died within the first year.

Results We included 1,533 infants. Preterm infants <35 weeks' gestation born in the breech versus vertex position had an incidence of DDH of 0.47% (2/428) and 0.36% (4/1,105), respectively. There was no significant difference in the incidence of DDH between infants born in the breech versus vertex position (Chi-square and Fisher's exact tests). The sensitivity, specificity, and positive and negative predictive values of breech presentation in detecting DDH were 33, 72, 0.47, and 99.6%, respectively.

Conclusion There is no association between breech presentation and DDH in preterm infants <35 weeks' gestation. Obtaining hip ultrasounds on preterm infants <35 weeks' gestation born in the breech presentation with a normal hip examination is not recommended.

Key Points

• Breech position is a risk factor for DDH in term newborns.

• Preterm infants are often in the breech position until 37 weeks' gestation.

• This study shows that breech presentation is not a risk factor for DDH in preterm infants.

Keywords

developmental dysplasia of the hip - prematurity - breech presentation - risk factors

Authors' Contributions

M.J.K. conceived the project, designed the study, analyzed the data, and reviewed and revised the manuscript. S.L. collected the data, analyzed the data, and drafted the initial manuscript.

Publication History

Received: 23 September 2021

Accepted: 12 July 2022

Article published online:
12 September 2022

• References

• 1 Shaw BA, Segal LS. Section on Orthopaedics. Section on Orthopaedics. Evaluation and referral for developmental dysplasia of the hip in infants. Pediatrics 2016; 138 (06) e20163107
• 2 Paton RW, Choudry Q. Developmental dysplasia of the hip (DDH): diagnosis and treatment. Orthop Trauma 2016; 30 (06) 453-460
• 3 Schaeffer EK, Study Group I, Mulpuri K. IHDI Study Group. Developmental dysplasia of the hip: addressing evidence gaps with a multicentre prospective international study. Med J Aust 2018; 208 (08) 359-364
• 4 Scott EJ, Dolan LA, Weinstein SL. Closed vs. open reduction/Salter innominate osteotomy for developmental hip dislocation after 18 months: comparative survival at 45-year follow-up. J Bone Joint Surg Am 2020; 102 (15) 1351-1357
• 5 Auriemma J, Potisek NM. Developmental dyplasia of the hip. Pediatr Rev 2018; 39 (11) 570-572
• 6 Paton RW, Hinduja K, Thomas CD. The significance of at-risk factors in ultrasound surveillance of developmental dysplasia of the hip. A ten-year prospective study. J Bone Joint Surg Br 2005; 87 (09) 1264-1266
• 7 Pollet V, Percy V, Prior HJ. Relative risk and incidence for developmental dysplasia of the hip. J Pediatr 2017; 181: 202-207
• 8 Sezer C, Unlu S, Demirkale I, Altay M, Kapicioglu S, Bozkurt M. Prevalence of developmental dysplasia of the hip in preterm infants with maternal risk factors. J Child Orthop 2013; 7 (04) 257-261
• 9 Cunningham FG, Leveno KJ, Bloom SL. et al. Normal labor. In: Cunningham FG, Leveno K, Bloom S. et al, eds. Williams Obstetrics, 25th ed. New York, NY: McGraw-Hill Education; 2018
• 10 Siegel MJ. Pediatric Sonography. 3rd ed.. Philadelphia, PA: Lippincott Williams & Wilkins; 2002
• 11 Biedermann R, Riccabona J, Giesinger JM. et al. Results of universal ultrasound screening for developmental dysplasia of the hip: a prospective follow-up of 28,092 consecutive infants. Bone Joint J 2018; 100-B (10) 1399-1404
• 12 Kang MS, Han GW, Kam M, Park S-S. Clinical significance of asymmetric skin folds in the medial thigh for the infantile screening of developmental dysplasia of the hip. Pediatr Neonatol 2019; 60 (05) 570-576
• 13 Marson BA, Hunter JB, Price KR. Value of the ‘clicky hip’ in selective screening for developmental dysplasia of the hip. Bone Joint J 2019; 101-B [phone]
• 14 Bond CD, Hennrikus WL, DellaMaggiore ED. Prospective evaluation of newborn soft-tissue hip “clicks” with ultrasound. J Pediatr Orthop 1997; 17 (02) 199-201
• 15 Perry DC, Paton RW. Knowing your click from your clunk: is the current screening for developmental dysplasia of the hip fit for purpose?. Bone Joint J 2019; 101-B [phone]
• 16 Bialik V, Bialik GM, Blazer S, Sujov P, Wiener F, Berant M. Developmental dysplasia of the hip: a new approach to incidence. Pediatrics 1999; 103 (01) 93-99
• 17 Barlow T. Early diagnosis and treatment of congenital dislocation of the hip. Proc R Soc Med 1963; 56 (09) 804-806
• 18 Fox AE, Paton RW. The relationship between mode of delivery and developmental dysplasia of the hip in breech infants: a four-year prospective cohort study. J Bone Joint Surg Br 2010; 92 (12) 1695-1699
• 19 Duramaz A, Duramaz BB, Bilgili MG. Does gestational age affect ultrasonographic findings of the hip in preterm newborns? A sonographic study of the early neonatal period. J Pediatr Orthop B 2019; 28 (02) 107-110
• 20 Tuncay IC, Karaeminogullari O, Demirörs H, Tandogan NR. Is prematurity important in ultrasonographic hip typing?. J Pediatr Orthop B 2005; 14 (03) 168-171
• 21 Azzopardi T, Van Essen P, Cundy PJ, Tucker G, Chan A. Late diagnosis of developmental dysplasia of the hip: an analysis of risk factors. J Pediatr Orthop B 2011; 20 (01) 1-7
• 22 Graf R, Tschauner C, Klapsch W. Progress in prevention of late developmental dislocation of the hip by sonographic newborn hip screening: Results of a comparative follow-up study. J Pediatr Orthop 1993; 2: 115-121