- A large-for-gestational age newborn girl who was born via caesarean section for breech presentation is ready for discharge from the newborn nursery at 72 hours of age. She has had an entirely normal newborn course.
- Of the following, you are MOST likely to advise the mother that her infant is at increased risk for
A. developmental dysplasia of the hip
B. positional deformity of the foot
C. positional plagiocephaly
D. recurrent hypocalcemia
E. recurrent hypoglycemia - Female sex, breech presentation, and family history have been suggested as contributing to the epidemiology of developmental dysplasia of the hip. Accordingly, the infant described in the vignette should be monitored for this condition. Initially believed to be a congenital dysplasia, it
now is understood that multiple factors are involved in developmental dysplasia of the hip, which may evolve and be detected after the immediate newborn period. - A careful history and attentive physical examination are important to detect an abnormal hip in the young infant. Imaging studies may be indicated in infants who are at high risk for the disease. Careful follow-up and physical
examination of infants at increased risk, especially females who had nonvertex presentations and those who have concerning findings on hip examination over the first 2 months after birth, is the standard of care, with imaging reserved for those at highest risk. Once concern for hip
dysplasia has been established, highly repetitious hip examinations should be avoided because the Ortolani and Barlow maneuvers may injure the hip capsule. Prompt imaging and referral should ensue. - Recent outcome-based epidemiologic studies suggest that imaging studies should be performed at 1 to 2 months of age rather than in the immediate postnatal period and should be
limited primarily to ultrasonography in early infancy. Routine imaging of all children based on risk is not effective from either a cost or detection standpoint. Minor anomalies seen on ultrasonography early in infancy often resolve. Later in infancy, anteroposterior and “frog-leg” position plain radiographs are more likely to be helpful in the child who has abnormal results on hip examination. - The large-for-gestational age infant described in the vignette, who is asymptomatic and has normal findings on physical examination prior to discharge, is unlikely to have an increased risk for recurrent hypocalcemia or hypoglycemia. Positional deformity of the foot is, by definition, transient, in contrast to talipes equinovarus deformity. Positional plagiocephaly is a risk for
infants placed in the supine sleep position; perinatal risk factors such as prematurity or abnormal muscle tone may predispose to dolichocephaly
Dr. Jayaprakash
Superintendent, ICH.
Institute of Child Health.
Gov. Medical College Kottayam.
Kerala, India.