Universal Ultrasound Screening
Moderate evidence supports not performing universal ultrasound screening of newborn infants.
MODERATE RECOMMENDATION Rationale
There is moderate evidence to not do universal screening of all infants for DDH. Two moderate strength studies showed no statistical difference between universal and selective ultrasound screening of the infant hip for diagnosis of late presenting DDH.1,2 Holen augmented clinical screening with either universal or selective (risk) ultrasound. The rate of late cases in Holen’s study was 0.13/1000 with universal ultrasound screening and 0.65/1000 with selective (risk) screening. The difference in late detection was not statistically significant. Rosendahl used three matched study groups: general ultrasound screening, risk factor screening and only clinical screening. Late cases identified by group were 0.3/1000, 0.7/1000 and 1.3/1000 respectively and these differences were not statistically significant.
Screening of all infants with ultrasound has the potential to lead to over-treatment. Rosendahl’s study found that general ultrasound screening resulted in a higher treatment rate (3.4%) than either selective ultrasound screening (2.0%) or clinical screening (1.8%). The higher rate with universal screening is statistically significant. Universal ultrasound screening requires considerable diagnostic and therapeutic effort and these studies which involve large numbers of newborns indicate that such a commitment of resources will not significantly impact the prevalence of late cases. Risks and Harms of Recommendation There is a potential to miss a case of DDH in an infant with a normal clinical examination and no risk factors. This could lead to a late diagnosis with concerns for a potential of higher rate of treatment complications as a result of late diagnosis.
Risks and Harms of Recommendation
There is a potential to miss a case of DDH in an infant with a normal clinical examination and no risk factors. This could lead to a late diagnosis with concerns for a potential of higher rate of treatment complications as a result of late diagnosis.
Screening of all infants with ultrasound has the potential to lead to over-treatment. Rosendahl’s study found that general ultrasound screening resulted in a higher treatment rate (3.4%) than either selective ultrasound screening (2.0%) or clinical screening (1.8%). The higher rate with universal screening is statistically significant. Universal ultrasound screening requires considerable diagnostic and therapeutic effort and these studies which involve large numbers of newborns indicate that such a commitment of resources will not significantly impact the prevalence of late cases. Risks and Harms of Recommendation There is a potential to miss a case of DDH in an infant with a normal clinical examination and no risk factors. This could lead to a late diagnosis with concerns for a potential of higher rate of treatment complications as a result of late diagnosis.
Risks and Harms of Recommendation
There is a potential to miss a case of DDH in an infant with a normal clinical examination and no risk factors. This could lead to a late diagnosis with concerns for a potential of higher rate of treatment complications as a result of late diagnosis.
- (1) Holen KJ, Tegnander A, Bredland T et al. Universal or selective screening of the neonatal hip using ultrasound? Journal of Bone and Joint Surgery - Series B 2002;84(6):886-890
- (2) Rosendahl K, Markestad T, Lie RT. Ultrasound screening for developmental dysplasia of the hip in the neonate: the effect on treatment rate and prevalence of late cases. Pediatrics 1994;94(1):47-52.