The infant hip check carried out in early infancy is missing many cases of developmental dysplasia, a new study* shows.
Developmental dysplasia of the hip (DDH) is a common cause of childhood disability with an incidence reportedly as high as 20 in every 1000 live births.
The newborn and infant screening guidance from Public Health England still recommends a ‘hip check’ at six to eight weeks after birth, although this is based on guidance produced by the Department of Health over 30 years ago and is not supported by up-to-date evidence, state the authors of a study published today online in the British Journal of General Practice (BJGP).
Orthopaedic surgeon Ronnie Davies and colleagues studied hip problems identified in a population of over 70,000 children in the north of England, over a period of 15 years. In the BJGP paper they report that the sensitivity and positive predictive value of the 6-8 week screening test are low (16.7% and 3.5% respectively), so that some cases of DDH will be missed, providing false reassurance to parents.
Over the 15-year study period, 30 children with late presenting DDH were identified.
The authors recommend a re-think of current guidance, perhaps with the introduction of a second assessment at three to four months. They also recommend that these assessments are performed in primary care, but emphasise the importance of training to ensure that they are carried out correctly.
Commenting, Chris Talbot, a co-author, said: “Developmental dysplasia of the hip (DDH) is an important childhood condition for which a selective screening programme is employed in the UK. Over 70,000 children were included within this arm of the assessment over a period of 15 years. With this part of the assessment yielding a low sensitivity and positive predictive value, there is a concern that DDH will not be identified at this check and parents falsely reassured.
“Assessment of clinical hip instability is a key sign during this assessment, as too limited hip abduction, and must be undertaken by all health professional at this time point. Despite this six to eight week assessment, in addition to risk factor screening and the neonatal examination, late presenting cases were still identified. It is recommended that there is a change in the UK screening programme to mitigate against the high number of late presenting DDH cases.”
The authors recommend an additional assessment at three to four months, and call for more emphasis to be placed on the training of healthcare professionals performing this assessment, and empowering parents to raise concerns such as those highlighted in the 'red book’.
*Davies R, Talbot C and Paton R. Evaluation of primary care 6- to 8-week hip check for diagnosis of developmental dysplasia of the hip: a 15-year observational cohort study. British Journal of General Practice, 24 February 2020; DOI:10.3399/bjgp20X708269