​Author(s): Choudry Q.A.; Paton R.W.
Source: Bone and Joint Journal; Jun 2018 (no. 6); p. 806-810
Publication Date: Jun 2018
Publication Type(s): Article
PubMedID: 29855244
Abstract:Aims The aim of this prospective cohort study was to evaluate the effectiveness of the neonatal hip instability screening programme. Patients and Methods The study involved a four-year observational assessment of a neonatal hip screening programme. All newborns were examined using the Barlow or Ortolani manoeuvre within 72 hours of birth; those with positive findings were referred to a 'one-stop' screening clinic for clinical and sonographic assessment of the hip. The results were compared with previous published studies from this unit. Results A total of 124 newborns with a positive Barlow or Ortolani manoeuvre, clunk positive, or 'unstable' were referred. 

​Author(s): Ashraf A.; Saeed U.; Alhadi O.; Asad-ur-Rehman; Iqbal S.
Source: International Journal of Pharmaceutical Sciences and Research; Jan 2018; vol. 9 (no. 1); p. 369-372
Publication Date: Jan 2018
Publication Type(s): Article
Abstract:Prostaglandins (PG) are commonly used in neonates with cyanotic congenital heart diseases to keep the ductus arteriosus patent. The definite treatment for these conditions is surgery. It is occasionally used for longer duration (weeks to months) in preterm babies. Reversible cortical hyperostosis is a relatively recently recognized side effect of prolonged prostaglandin therapy. We describe the case of an infant presenting this complication secondary to prolonged use of PGE1, with typical and extensive radiological findings. The enzymes (prostaglandin 15-OH dehydrogenase & prostaglandin -13 reductase) that catalyze the degradation of prostaglandins are widely distributed in many vascular beds including those of the spleen, kidney, adipose tissue, intestine, liver, testicles and lungs. PGE is normally rapidly inactivated by these tissues, particularly during passage through the lungs.18 However, infants with cyanotic congenital heart diseases that cause decreased pulmonary blood flow and reduced clearance of PGE may have a higher systemic concentration of PGE. In addition, these patients often receive pharmacologic doses of PGE to maintain the patency of the ductus arteriosus. The resultant higher PGE concentration in the blood may result in osseous changes. However the exact mechanism of cortical hyperostosis is not yet known. It may be a direct, dose-related stimulation of osteoblastic cells. Copyright © 2013 are reserved by International Journal of Pharmaceutical Sciences and Research.
Database: EMBASE

Author(s): Talbot C.; Adam J.; Paton R.

Source: Bone and Joint Journal; Sep 2017 (no. 9); p. 1250-1255

Publication Date: Sep 2017

Publication Type(s): Article

Abstract:Aims Despite the presence of screening programmes, infants continue to present with late developmental dysplasia of the hip (DDH), the impact of which is significant. The aim of this study was to assess infants with late presenting dislocation of the hip despite universal clinical neonatal and selective ultrasound screening. Patients and Methods Between 01 January 1997 to 31 December 2011, a prospective, longitudinal study was undertaken of a cohort of 64 670 live births. Late presenting dislocation was defined as presentation after three months of age. Diagnosis was confirmed by ultrasound and plain radiography. Patient demographics, referral type, reason for referral, risk factors (breech presentation/strong family history) and clinical and radiological findings were recorded. Results There were 31 infants with an irreducible dislocation of the hip, an incidence of 0.48 (95% confidence interval (CI) 0.34 to 0.68) per 1000 live births. Of these, 18 (0.28 (95% CI 0.17 to 0.44) per 1000 live births; 58%) presented late. All infants had a documented normal newborn clinical examination and no abnormality reported in the six to eight week check. Of the 18 late presenting cases 72% (n = 13) had no risk factors: 16 were referred by GPs and two were late due to administrative issues (missed appointments). The mean time to diagnosis was 62.4 weeks (19 to 84). Conclusion Despite universal clinical neonatal and selective ultrasound screening, late cases of irreducible hip dislocation still occur. We recommend an update of the national screening programme for DDH, a review of training and education of healthcare professionals involved in the physical examination of neonates and infants, and the addition of a further assessment after the six to eight week check.Copyright © 2017 The British Editorial Society of Bone & Joint Surgery.
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Database: EMBASE

Citation: Bone and Joint Journal, February 2015, vol./is. 97B/2(265-269), 2049-4394;2049-4408 (01 Feb 2015)

Author(s): Mace J., Paton R.W.

Institution: (Mace, Paton) Department of Orthopaedic Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, United Kingdom, (Mace) Northwest Deanery Royal Blackburn Hospital, Haslingden Road, Blackburn, Lancashire BB2 3HH, United Kingdom, (Paton) University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom

Language: English

Abstract: Over a 15-year prospective period, 201 infants with a clinically unstable hip at neonatal screening were subsequently reviewed in a 'one stop' clinic where they were assessed clinically and sonographically. Their mean age was 1.62 weeks (95% confidence interval (CI) 1.35 to 1.89). Clinical neonatal hip screening revealed a sensitivity of 62% (mean, 62.6 95%CI 50.9 to 74.3), specificity of 99.8% (mean, 99.8, 95% CI 99.7 to 99.8) and positive predictive value (PPV) of 24% (mean, 26.2, 95% CI 19.3 to 33.0). Static and dynamic sonography for Graf type IV dysplastic hips had a 15-year sensitivity of 77% (mean, 75.8 95% CI 66.9 to 84.6), specificity of 99.8% (mean, 99.8, 95% CI 99.8 to 99.8) and a PPV of 49% (mean, 55.1, 95% CI 41.6 to 68.5). There were 36 infants with an irreducible dislocation of the hip (0.57 per 1000 live births), including six that failed to resolve with neonatal splintage. Most clinically unstable hips referred to a specialist clinic are female and stabilise spontaneously. Most irreducible dislocations are not identified from this neonatal instability group. There may be a small subgroup of females with instability of the hip which may be at risk of progression to irreducibility despite early treatment in a Pavlik harness. A controlled study is required to assess the value of neonatal clinical screening programmes.

Country of Publication: United Kingdom

Publisher: British Editorial Society of Bone and Joint Surgery

Publication Type: Journal: Article