Ultrasound Examination for Infants Born Breech by Elective Cesarean Section With a Normal Hip Exam for Instability.
BACKGROUND
Because of the risk of developmental dysplasia of the hip in infants born breech-despite a normal physical exam-the American Academy of Pediatrics (AAP) guidelines recommend ultrasound (US) hip imaging at 6 weeks of age for breech females and optional imaging for breech males. The purpose of this study is to report US results and follow-up of infants born breech with a normal physical exam.


METHODS
The electronic medical record for children born at 1 hospital from 2008 to 2011 was reviewed. Data were analyzed for sex, birth weight, breech position, birth order, ethnicity, US and x-ray results, follow-up, and cost.


RESULTS
A total of 237 infants were born breech with a normal physical examination, all delivered by cesarean section. Of the infants, 55% were male and 45% female. About 151 breech infants (64%) with a normal Barlow and Ortolani exam had a precautionary hip US as recommended by the AAP performed at an average of 7 weeks of age. Eighty-six breech infants (35%) did not have an US and were followed clinically. Of the 151 infants that had an US, 140 (93%) were read as normal. None had a dislocated hip. Two patients had a normal physical exam but laxity on US. These 2 patients were the only infants treated in a Pavlik harness. A pediatric orthopaedic surgeon followed those with subtle US findings and no laxity until normal.


CONCLUSIONS
The decision by the AAP to recommend US screening at 6 weeks of age for infants with a normal physical exam but breech position was based on an extensive literature review and expert opinion. Not all pediatricians are following the AAP guidelines. The decision to perform an US should be done on a case-by-case basis by the examining physician. A more practical, cost-effective strategy would be to skip the US if the physical exam is normal and simply obtain an AP pelvis x-ray at 4 months.


METHODS
Level III-this is a case-control study investigating the outcomes of infants on data drawn from the electronic medical record.
Department of Orthopedics, Penn State College of Medicine, Hershey, PA.
Matthew J
MJ
Pacana
William L
WL
Hennrikus
Jennifer
J
Slough
William
W
Curtin
D001946:Breech Presentation / Q000601:surgery*; D016022:Case-Control Studies; D002585:Cesarean Section / Q000379:methods; D005260:Female; D006618:Hip Dislocation, Congenital / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007593:Joint Instability / Q000175:diagnosis*; D008297:Male; D010808:Physical Examination / Q000379:methods; D011247:Pregnancy; D018570:Risk Assessment / Q000379:methods; D014463:Ultrasonography / Q000379:methods*