Turkiye Klinikleri Journal of Pediatrics

.: ORIGINAL RESEARCH
Our Four-Years Results of Developmental Hip Dysplasia Screening Program in Newborns
Yenidoğanlarda Dört Yıllık Gelişimsel Kalça Displazi Tarama Sonuçlarımız
Hamza YAZGANa, Esengül KELEŞa, Arzu GEBEŞÇİa, Mehmet DEMİRDÖVENa, Bülent BAŞTÜRKa, Ömer ETLİKb
Clinics of
aPediatrics,
bRadiology. Private Sema Hospital, İstanbul
Turkiye Klinikleri J Pediatr 2012;21(1):7-10
Article Language: EN
ABSTRACT
Objective: To share the results of a developmental dysplasia of the hip screenings programmes and discuss the topic within the framework of current literature. Material and Methods: A total of 2653 newborns, who were born in our clinic between 14th January, 2006 and 25th September, 2010 were enrolled in the study and 2541 of the babies had their ultrasonography tests done. However, the remaining 112 were excluded from the study because they did not continue outpatient follow up care at the hospital. The intervention group (n=2653) was screened by an ultrasound examination of the hip at the age of 4-5 weeks and the ultrasound examinations were performed by radiologists using Graf's method. Results: Of the infants included in the study, 1311 (51.6%) were girls, 1230 (48.4%) were boys, 2413 were type I a hips (94.9%), 113 were type II a hips (4.4%), 8 were type II c hips (0.31%), 4 were type II d hips (%0.15), and 3 were bilateral type III a hips (0.11%). Type I a infants were not followed. Infants with hips designated as type II c and above were referred to orthopedics and immediate treatment was initiated (Pavlik harness). Type II a infants were re-evaluated a month later with ultrasonography, and all results were type I a. Among the infants who were observed and referred to orthopedics (n=128) , sixty nine (53.9%) carried at least one of the following risk factors such as being female, born with breech presentation, member of multiple gestation or a history of oligohydramnios. However, 59 infants (46.1%) had no risk factors. Physical findings such as asymmetry of gluteal and thigh skin folds, abnormal feet deformity, limitation of hip abduction or torticollis were detected in 36 (28%) cases. However, 92 (72%) cases had normal physical examination and one of the cases needed surgical intervention. Conclusion: In order not to fail to diagnose the DDH, it is very important to perform USG within the first months of life in all newborns to decrease the morbidity. It is socially and judicially important for physicians, especially for those who are following babies born in distant provinces, where no radiologists are available or accessible, to perform the relevant examinations more meticulously and carefully.

Keywords: Infant, newborn; morbidity; hip dislocation, congenital; ultrasonography
ÖZET
Amaç: Gelişimsel kalça displazi tarama programı sonuçlarımızı bildirmek ve güncel literatür eşliğinde tartışmak. Gereç ve Yöntemler: Çalışmaya 14 Ocak 2006 ve 25 Eylül 2010 tarihleri arasında doğan 2653 yenidoğan dâhil edildi. 112 yenidoğan hastanemize devam etmediği için çalışma dışı bırakıldı. 2541 bebeğin kalça ultrasonografileri ilk bir ay içinde (4-5 haftalık) radyologlar tarafından yapıldı ve Graf metoduna göre değerlendirildi. Bulgular: Bebeklerden 1311 (%51,6)'i kız, 1230 (%48,4)'u erkek idi. Olgulardan 2413 (%94,9)'ünde tip I a, 113 (%14,4)'ünde tip II a, 8 (%0,31)'inde tip II c, 4 (%0,15)'ünde tip II d ve 3 (%0,11)'ünde de bilateral tip III a tespit edildi. Tip I a'lar izlem dışı bırakıldı. Tip II c ve üstü kalçalar ortopediye sevk edildi ve tedavilerine başlandı (pelvik bandaj). Tip II a'lar ise takip edilerek bir ay sonra yapılan kontrol ultrasonografilerinde sonuçlar tip I a olarak değerlendirildi. Takibe alınan ve ortopediye sevk edilen (n:128) olgulardan 69 (%53,9)'unda; kız bebek, makat geliş, çoğul gebelik ve oligohidramniyoz gibi risk faktörleri belirlenirken, 59 (%46,1)'unda ise herhangi bir risk faktörü saptanamadı. Pili asimetrisi, ayak deformitesi, abdüksiyon kısıtlılığı ve tortikolis gibi fizik bulgular 36 (%28) olguda tespit edilirken, 92 (%72) olgunun fizik muayenesi normaldi. Cerrahi müdahale gerektiren olgu olmadı. Sonuç: Gelişimsel kalça displazilerinin atlanmaması için tüm yenidoğanlarda ilk aylarda kalça ultrasonografisinin yapılması morbiditeyi azaltmakta olup, radyoloji uzmanının olmadığı veya ulaşılamadığı merkezlerde, yenidoğan bebeklerin takibini yapan hekimlerin bu konuda daha titiz ve özenle hareket etmesi, sosyal ve adli açıdan önem arz etmektedir.

Anahtar Kelimeler: Bebek, yenidoğan; morbidite; kalça çıkığı, doğumsal; ultrasonografi

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