276 - Incidence and Screening Practices of Developmental Dysplasia of Hip in Preterm Breech Infants

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 276
Publication Number: 276.131

Cole Turner, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Kashif Iqubal, Hassenfeld Children's Hospital at NYU Langone, Jersey city, NJ, United States; Erin Hanft, NYU Langone, New York, NY, United States; Zachary Henig, New York University Grossman School of Medicine, Millstone, NJ, United States; Alyssa Khoo, New York University Grossman School of Medicine, New York, NY, United States

Presenting Author(s)

Cole Turner, DO (he/him/his)

Neonatal-perinatal Medicine Fellow
Hassenfeld Children's Hospital at NYU Langone
New York, New York, United States

Background: Breech presentation in the third trimester is a strong risk factor for Developmental Dysplasia of Hip (DDH). The American Academy of Pediatrics published clinical practice guidelines in 2000 recommending ultrasound (US) screening at six weeks of age for infants born breech but these guidelines do not comment on US screening for preterm infants. Reports suggest that prematurity is protective against DDH with incidence of DDH in the preterm breech population reported as 2-14% vs 12-24% in term breech infants. The timing of US should be considered as early screening may reflect physiologic immaturity rather than true dysplasia.

Objective: Objectives were to determine the incidence of DDH in preterm breech infants at our institution and to evaluate the screening practices among providers that manage DDH in the preterm population.

Design/Methods: This chart review was performed at New York University Langone Health (NYU) analyzing infants born from 2012-2022. Only those infants who were born < 37 weeks gestation age (GA), had breech presentation and had screening US done at NYU were included. Infants with genetic syndromes were excluded. Data was extracted using Epic Slicer/Dicer and collected using RedCAP. Analysis included obstetric history of the mother, labor and delivery information, diagnosis of DDH and timing of screening. A survey assessing provider screening practices in relation to DDH in preterm infants was sent to pediatricians, neonatologists and pediatric orthopedists.

Results:

2796 charts were reviewed, 147 met inclusion criteria. An overall incidence of DDH was found to be 6.1% (9/147) with 5.6% (1/18) in < 32 weeks GA infants and 6.2% (8/129) in 32-37 weeks GA infants. Infants with DDH were more likely to have oligohydramnios: 50% versus 8.3% (p =0.023). Screening before 40 weeks of corrected GA was performed in 34.7% (51/147) of all infants and in 66.7% (6/9) of infants with DDH.
234 physicians responded to the survey: 168 neonatologists, 46 pediatric orthopedists and 20 pediatricians. A large majority from each group believed this population should be screened (Fig 1). While the majority believe both preterm and late preterm breech infants should be screened at 6 weeks corrected age, survey results showed discordance among current screening practices (Fig 2 and Fig 3).

Conclusion(s): Incidence of DDH in preterm breech infants is lower than the reported incidence in the term breech population and clinicians should consider this prior to US screening. There exists variation in provider practices for screening preterm breech infants suggesting a need for updated clinical guidelines.