Hip Ultrasound for Newborns with Breech Presentation
Yes, you should get an ultrasound of the hips for your newborn with breech presentation to assess for developmental dysplasia of the hip (DDH), as recommended by the American Academy of Pediatrics. 1, 2
Rationale for Hip Ultrasound in Breech Babies
Breech presentation is a significant risk factor for developmental dysplasia of the hip (DDH), which if left untreated can lead to:
- Premature osteoarthritis
- Avascular necrosis of the femoral head
- Long-term mobility issues
- Need for surgical intervention
Risk Assessment
- Breech presentation significantly increases DDH risk
- Female infants born breech have the highest risk
- Male infants born breech have moderate risk
- The risk remains even with normal physical examination findings
Timing of Ultrasound
- Optimal timing: 6 weeks of age 1, 2
- Not recommended immediately after birth (before 2 weeks) as:
- Hip instability often resolves spontaneously by 2 weeks
- Early screening leads to higher false positives and overtreatment 2
Evidence Supporting Ultrasound Screening
The American Academy of Pediatrics specifically recommends:
- Hip imaging for all female infants born in breech position
- Optional hip imaging for male infants born in breech position 1
Studies show that selective ultrasound screening is worthwhile for breech infants:
- In a study of 52,893 infants, ultrasound examination of high-risk infants (including breech presentation) identified 0.33% with dislocated hips and 2.78% with dysplastic hips 1
- About 27% of breech infants with clinically stable hips were found to have abnormalities on ultrasound screening 3
Follow-up Recommendations
Even with a normal ultrasound at 6 weeks:
- Consider a follow-up radiograph at 4-6 months of age
- One study found that 29% of breech infants with normal ultrasounds at 6 weeks showed evidence of dysplasia requiring treatment at 4-6 months 3
- Another study found 10% of hips in breech infants with normal ultrasounds showed radiographic evidence of late DDH 4
Important Considerations
- Normal physical examination does not rule out DDH in high-risk infants like those with breech presentation 1
- Early detection allows for non-surgical treatment options (like Pavlik harness)
- Delayed diagnosis (after 6 months) often requires surgical intervention
- Ultrasound is preferred for infants under 4 months; radiographs become more reliable after 4-6 months 2
Potential Pitfalls
- Overdiagnosis and overtreatment: Some studies show high rates of overdiagnosis with universal ultrasound screening 5
- False reassurance: A normal ultrasound at 6 weeks doesn't completely rule out later development of DDH 3, 4
- Delayed follow-up: Missing the recommended follow-up radiograph at 4-6 months may lead to missed cases of late-developing DDH
By following the recommended screening protocol, you can significantly reduce the risk of complications from undiagnosed DDH while minimizing unnecessary treatment.