Ultrasound of the hip joints of a new-born
What is hip dysplasia in a new-born? When to ultrasound the hips of a new-born and infant?
Justyna Łuszczki, MD:
What is hip dysplasia?
Hip dysplasia is a defect that can arise in the prenatal, perinatal and neonatal periods.
There are many causes of hip dysplasia. The defect may be caused by genetic factors, incorrect location of the foetus in the uterus (pelvic position of the foetus, transverse position). The position of the foetal limbs also promotes the development of the defect. In combination with limited mobility in the womb – a tight uterus, particularly insusceptible uterine wall and the elemental muscles, oligohydramnios, twin pregnancy, high birth weight, put pressure on the hip joints in the foetus, contributing to the defect.
In the neonatal period, a slightly more flaccid joint capsule is observed, which is caused by the effect of estrogens on the ligaments and capsules. Girls are more sensitive to the effects of estrogens, which explains the more frequent occurrence of the defect in the female sex.
Undetected dysplasia of the hip joints or their dislocation result in improper positioning of the limb, limping while walking or the so-called „waddling”.
Who is affected?
Congenital dysplasia occurs in approximately 5% of new-borns, and dislocation of the hip joint occurs in approximately 1%.
The disorder is more common in girls.
Increased risk of hip dysplasia occurs in children with abnormal position – pelvic (buttock) position and with hip dysplasia in the family.
In the neonatal and early infancy period (up to about 12 weeks of age), physiological immaturity of the hip joints is observed.
Pregnancy complicated by oligohydramnios, twin pregnancy, high birth weight of the child (> 4000 g), abnormalities in the child found after delivery, e.g. torticollis, incorrect position of the feet – these are factors that may affect the abnormal development of the hip joints.
How to detect hip dysplasia or dislocation?
Already during the first physical examination of the newborn, the neonatologist examines the hip joints.
There are several clinical symptoms that may indicate hip abnormalities (Ortolani, Barlow, Galeazzi symptom, asymmetry of buttock folds and limited abduction in hip joints). If, in a clinical examination of the child’s hips, the doctor finds deviations from the norm
performing an ultrasound of the new-born’s hip joints is necessary. The clinical symptoms in the diagnosed dysplasia or dislocation are not always positive.
The basic additional examination is ultrasound of new-born hips. Ultrasound of the hip joints is the surest method of diagnosing dysplasia.
A hip ultrasound scan is not compulsory, but a hip ultrasound screening is recommended for every new-born or infant.
When to do an ultrasound of the hip joints of a new-born and infant?
The earlier diagnosed hip dysplasia, the better and faster treatment results.
The ideal would be if every new-born could have an ultrasound of the hip joints during their stay in the neonatal unit.
It is recommended that the first ultrasound of the new-born’s hip joints should be performed not later than 4-6 weeks of life.
If the new-born is at risk of hip dysplasia (family history of pelvic position, dysplasia) or there is any abnormality in the clinical examination, a hip ultrasound should be performed as soon as possible.
Hip joints develop as the baby grows. Due to the fact that the physiological immaturity of the hip joints is observed up to about 3 months, usually after the child is 3 months old, the examination is performed to assess whether the hip joints have achieved the correct shape in relation to their age.
The time of the next examination is determined individually by the doctor based on the results obtained.