Clin Exp Pediatr > Accepted Articles
DOI: https://doi.org/10.3345/cep.2021.01074    [Accepted]
Published online November 5, 2021.
Risk factors and screening timing for developmental dysplasia of the hip in preterm infants
Ga Won Jeon1  , Hye Jung Choo2  , Yong Uk Kwon3 
1Department of Pediatrics, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
2Department of Radiology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
3Department of Orthopaedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
Correspondence: 
Ga Won Jeon, Tel: 82.51-890-6497, Fax: 82-51-890-5830, Email: iamgawon@hanmail.net
Received: 31 July 2021   • Revised: 7 October 2021   • Accepted: 12 October 2021
Abstract
Background
The delayed diagnosis of developmental dysplasia of the hip (DDH) requires complex treatment and sometimes progresses to hip osteoarthritis regardless.
Purpose
This study aimed to evaluate the risk factors and screening time for DDH in preterm infants.
Methods
A total of 155 preterm infants with a gestational age < 32 weeks screened for DDH with ultrasonography were enrolled in this retrospective chart review.
Results
The incidence of DDH was 6.45% (10/155). Gestational age, birth weight, sex ratio, and breech presentation did not differ significantly between infants treated for DDH (n = 10) and non-treated infants (n = 145) (gestational age, 29.2 ± 1.4 weeks vs. 29.6 ± 2.0 weeks, p = 0.583; birth weight, 1240 ± 237 g vs. 1295 ± 335 g, p = 0.607; female sex, 7/10 (70.0%) vs. 77/145 (53.1%), p = 0.346; and breech presentation, 5/10 (50.0%) vs. 43/145 (29.7%), p = 0.286, respectively). Performing the first ultrasonography earlier than 38 weeks of postmenstrual age (PMA) increased the risk of an abnormal finding by 3.76 times compared to performing it at ≥ 38 weeks of PMA. These abnormal findings on ultrasonography resolved spontaneously. Breech presentation increased the risk of minor abnormal findings on the first ultrasonography by 3.11 times versus non-breech presentation and resolved spontaneously. DDH in preterm infants did not occur predominantly on the left side or in infants born with breech presentation.
Conclusion
Performing ultrasonography screening earlier than 38 weeks of PMA caused unnecessary subsequent ultrasonography and overtreatment. Breech presentation was not a risk factor for DDH in preterm infants. However, breech presentation could increase the risk of minor abnormal findings at the 1st ultrasonography compared to non-breech presentation, which resolved spontaneously. The etiology and risk factors for DDH in preterm infants are somewhat different from those for DDH in term infants.
Key Words: Breech presentation, Developmental dysplasia of the hip, Infant, Premature, Osteoarthritis, Hip, Ultrasonography


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