Evaluation of the Use of Ultrasounds in the Diagnosis of Developmental Dysplasia of the Hip in Premature Breech Newborns

Objectives This study aimed to determine if routine hip ultrasound (US) screening for developmental dysplasia of the hip (DDH) in preterm breech infants is an ideal utilization of resources, and to evaluate whether a specific gestational age (GA) category with breech presentation increases DDH risk. Study Design This is a retrospective chart review of 300 infants born in breech at <37 weeks between January 2013 and December 2021, admitted to Cooper University Hospital. Demographic data, DDH risk factors, and results of DDH screenings on physical exam and US were collected. Descriptive analysis was completed. Results Of the 300 preterm breech infants, there was only 1 case of DDH (0.3% incidence). This infant had positive findings of DDH on physical exam and US at 44 to 46 weeks corrected GA and was born at 29 weeks. Of 155 preterm breech newborns born at <29 weeks, there were no patients who had positive findings for DDH on physical exam or US. All patients who had negative physical exam findings were negative for DDH on US. Conclusion Despite the presence of known DDH risk factors in our population, the incidence in preterm breech newborns was 0.3%, lower than incidences reported in the current literature. Of infants born at <29 weeks, there were no infants who had a positive diagnosis of DDH on physical exam or on US. Universal US screening of very preterm breech infants born at <29 weeks may not be necessary due to the significantly lower prevalence of DDH in this population, especially in the absence of positive findings for DDH on prior physical exams. Key Points Hip US is indicated for infants born in breech presentation. This study shows a low prevalence of DDH in premature breech babies. This study showed no DDH in premature breech infants born at <29 weeks. Infants born at <29 weeks with normal hip exam may not need US screening for DDH.