330 - Screening for Developmental Dysplasia of the Hip in Breech Preterm Infants: Current Knowledge and Practices from Obstetrics, Pediatrics and Orthopedics

Publication Number: 4324.330

Angela C. Judd, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States; Abhinav Parikh, NewYork-Presbyterian Komansky Children’s Hospital, Brooklyn, NY, United States

Background: The American Academy of Pediatrics recommends ultrasound (US) screening for developmental dysplasia of the hip (DDH) at six weeks of life for infants with a history of breech position in the third trimester. Without specific recommendations for premature infants, screening practices may differ significantly. Since multiple specialties are involved in this condition, improving guidelines requires interdisciplinary discussion.

Objective: This study encourages interdisciplinary discussion by comparing current practices for screening US in the setting of premature infants born in breech position across specialties.

Design/Methods: Survey of general pediatric (PG), NICU, general obstetric (OB), maternal fetal medicine (MFM), and pediatric orthopedic (PO) attendings at a Level III NICU associated with a large academic hospital system. Experience levels ranged from one year to greater than 20 years of experience.

Results: Infants born in breech position at 32-37 weeks: 53% of attendings recommended screening based on corrected age (50% PG, 80% NICU, 100% PO). Chronological age was recommended by 24% (50% PG, 33% OB). Screening was not recommended in this scenario by 12% (20% NICU, 30% OB).
Infants born in breech position at 28-32 weeks: 47% of attendings recommended screening based on corrected age (33% PG, 80% NICU, 100% PO). Chronological age was recommended by 18% (33% PG, 33% OB). Screening was not recommended in this scenario by 18% (17% PG, 20% NICU, 30% OB).
Infants born in breech position less than 28 weeks: same results as 28-32 week scenario.
OB and MFM had the highest percentage of reporting "unsure" for their recommendation (33% term, 52% preterm).

Conclusion(s): Recommended timing of DDH US screening for premature infants differ between and within specialties. In this study the majority of NICU and orthopedic attendings reported using corrected age whereas general pediatricians were more varied with equal number using corrected or chronologic. Some NICU attendings commented that while it is their practice to screen all infants delivered breech, they suspected that infants born before the third trimester would not have increased risk. General pediatricians and obstetricians appeared to also suspect this as they were less likely to recommend screening for infants delivered breech at < 32 weeks. This aligns with new studies indicating that the lower the gestational age at birth the lower the relative risk of breech positioning. The differences in practice demonstrated in this study as well as new research findings highlight the need for development of more specific DDH screening guidelines.

DDH US Screening Recommendations Depending on Gestational Age at Birth
Percent of attending physicians using corrected versus chronological age when planning timing of ultrasound screening based on the gestational age at breech delivery.