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

Objective: To evaluate the incidence of Developmental Hip Dysplasia (DDH) in preterm breech infants at our institution and screening practices among providers that manage DDH in the preterm population. Design: We reviewed charts of infants born in a single quaternary care urban medical center between 2012-2022. Infants born <37 weeks Gestation Age (GA) with breech presentation and screening ultrasonography done within the system were included. Infants with genetic syndromes were excluded. Data were extracted using Epic Slicer/Dicer and collected using RedCAP. A survey assessing provider screening practices concerning DDH in preterm infants was sent to pediatricians, neonatologists, and orthopedists. Results: Two thousand seven hundred ninety six charts were reviewed, and 147 met the 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. 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. A large majority of each group believed this population should be screened. While most think both preterm and late preterm breech infants should be screened at 6 weeks corrected age, survey results showed discordance among current screening practices. Conclusion: The incidence of DDH in preterm breech infants is lower than the reported incidence in the term breech population, and clinicians should consider this before ultrasound screening. Additionally, variation exists in provider practices for screening preterm breech infants suggesting a need for updated clinical guidelines.