FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2413502308> ?p ?o ?g. }

• W2413502308 endingPage "18" @default.
• W2413502308 startingPage "16" @default.
• W2413502308 abstract "Original ArticleNeonatal Hip Instability in Saudi Arabia: Results And Cost Effectiveness Khalid Al-UmranMD Khalid Al-Umran Search for more papers by this author Published Online:1 Jan 1994https://doi.org/10.5144/0256-4947.1994.16SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutAbstractThe benefits of screening hips at birth for congenital dislocation have been repeatedly confirmed but doubts have been raised about the need for splinting all positive cases. Experience from an ongoing screening program, now in operation for over 11 years, is presented particularly with reference to cost benefit of screening and early surgical intervention. Of 30,651 live born babies screened for congenital dislocation of the hip (CDH) employing Barlow and Ortolani maneuvers, 132 were found to be positive, giving an incidence of two to six per 1000 live births, averaging 4.3/1000 for the period. The implications of epidemiologic and clinical observations and of management have been discussed. The cost of screening and of surgical management of cases that would not have stabilized without splinting has been resolved, even assuming that three of four positive cases might have stabilized without intervention. Cost effectiveness of a screening program for CDH was observed from this 11 year study, fully justifying a sustained program apart from the human misery an overlooked diagnosis may cause.IntroductionAn unstable hip at birth can bring untold misery to a child and his/her family and impose avoidable expenditure on later surgical intervention. Experiences in the Eastern Province of Saudi Arabia are evidence in point.1,2 The benefits of screening are substantial and very few cases are overlooked at birth if a sustained screening program is in operation.3 Routine screening of all neonates at the King Fahd Hospital of the University (KFHU) began in 1982G, with the necessary cooperation between the Departments of Pediatrics and Orthopedics in the diagnosis and management of neonates with unstable hips. This communication presents its experience of an 11 year study of an ongoing screening and early intervention program with special reference to cost effectiveness.Patients and MethodsAll babies delivered at the KFHU, Al-Khobar, Saudi Arabia since 1 January 1982G have been examined routinely for hip instability employing the Barlow and Ortolani maneuvers. This examination is carried out within 24 hours of birth. Confirmation of a positive screening test is determined by an orthopedic surgeon.Radiologic examination is not carried out routinely. A von Rosen splint is applied to those positive on screening with necessary written and verbal instructions to the parents, and followed up by an orthopedic surgeon. After six to 10 weeks, the splint is removed, with further follow-up at three, six and 12 months (x-ray films taken at three and 12 months). For statistical analysis of the results, the chi-square test has been used.ResultsDuring the 11 year study, a total of 30,651 live births were subjected to screening for hip instability as described. The yearly breakdown between 1982G and 1992G is shown in Table 1. Of the 30,651 babies, 132 were positive, giving a yearly incidence varying between 2.0 and 6.0/1000 live births, averaging 4.3/1000 for the period. The sex ratio was 1:3.7, the female predominating. Of the 132 babies positive on screening, three were small, 109 appropriate and 20 large for gestational age. Eighteen babies were delivered by breech (13.6%). The distribution of hip instability with respect to sidedness and sex appears in Table 2. A positive family history (first degree relatives) could be obtained in nine (6.8%) babies. Additional deformities observed in 19 (14.4%) babies were talipes equinovarus, congenital heart disease, microcephaly, meningocele, hypospadias and inguinal hernia (Table 3). Ninety-nine cases (74%) could be followed up to the age of walking. No complications were observed except minor skin irritation from the splint; one case required surgical intervention resulting from noncompliance by the parents. None of the positive cases returned after the follow-up period to report any hip problem.Table 1 Annual incidence of neonatal hip instability in deliveries at the KFHU, 1982–1992.YearLive Births+ve CasesIncidence/10001982201242.019832394104.219842630145.319852817165.719862842176.019872855113.819883017103.319893154134.119903148154.81991254952.019923233175.3 Total306511324.3KFHU=King Fahd Hospital of the University; +ve=positive.Table 2 Sex and side of defect in unstable hips.BilateralRightLeftTotalFemale232952104Male145928 Total373461132Table 3 Incidence of anomalies in 132 cases associated with unstable hips.AnomaliesNumber of CasesTalipes equinovarus7Congenital heart disease3Microcephaly2Meningocele3Hypospadia2Inguinal hernia2 Total19 (15.4%)DiscussionThe yearly incidence of congenital hip dysplasia in this region averages 4.3/1000 live births with a range of 2.0 to 6.0/1000 as determined by a large study of 30,651 babies examined between 1982G to 1992G. Considering the varying incidences in different regions of the world from 2.5 to 20/1000, the incidence of 4.3/1000 cannot be considered high as has been suggested.3 Consanguineous marriages, which are common in Saudi Arabia,4 would not appear to be the major causative factor, since some regions of the world where such marriages are uncommon have higher incidences of unstable hip.3,5,6 Predominance of female babies,8 higher frequency of involvement of the left hip9 and of breech deliveries appear to be common denominators as reported here and in other studies.8,10–12 Whereas both high and low birth weights have been shown to increase the risk for hip instability,10 prevalence of hip dislocation and other congenital anomalies in first degree relatives was significantly higher in the present series.The fact that no baby (apart from five during the initial year of study) in the follow-up service of the screening program was found to present later with hip dislocation may testify to the efficiency of the splinting procedure. However, the cost effectiveness of sustaining the program should be reviewed in the light of doubts raised about the need for splinting all positive cases.13 It has also been suggested that the head of the femur and the ligaments of the knee could be damaged if the screening is not carried out gently. Despite reports of hip joint damage following splintage,14 this has not been a problem in the population presented in our study. No case of femoral head necrosis was observed using the von Rosen splint.1It is suggested that three to five babies may be splinted unnecessarily for every one benefiting from the procedure.2,15 Yet considering: a) the serious long-term morbidity in overlooked cases; b) the poor results of late intervention; and c) the lack of complications and minor inconvenience of the splintage, it may be argued that the screening and management program should continue. From the viewpoint of health care costs, assuming that one of four cases would not have stabilized without splinting, 33 of the 132 positive cases would have required surgery. Allowing conservatively for a six week stay in hospital per child at SR 1000 per day, total hospitalization costs for the 33 cases would have been approximately SR 1.4 million. This figure does not include bilateral cases and cases where the diagnosis is delayed two to three years or more, where hospitalization periods may be longer. Also excluded are the actual surgical and transportation expenses for the relatives to and from the hospital with associated loss of work time. In contrast to costs of hospitalization, screening/splinting programs are cheap. In this study, the screening of 30,651 cases over the 11 year period (average eight per day) incurred estimated salary costs of SR 40,000 based on two minute examinations per infant. Added to this was the cost of splinting the positive cases (132) at SR 200 per splint, amounting to SR 26,400 and of radiographic costs at SR 50 per patient amounting to SR 6600 - total SR 73,000. Cost of screening, splinting and radiography (SR 73,000) totals approximated 5% of the cost of surgery (SR 1 4 million) for those cases expected to deteriorate without splinting. Thus, the tremendous cost effectiveness and prevention of suffering and misery of the child and his parents leave little doubt as to the necessity of sustaining the program as an essential public health service.ARTICLE REFERENCES:1. Al Umran K, Ahlberg A, Dawodu AH, et al. Neonatal screening for hip instability: five years’ experience . Ann Saudi Med. 1988; 8(6):425-9. Google Scholar2. Abu-Nawarig M. Congenital dysplasia of hip in Eastern Province of Saudi Arabia . Orthop Rev. 1981; 10(12):35-9. Google Scholar3. Leek I. An epidemiological assessment of neonatal screening for dislocation of the hip . JR Coll Physicians Lond. 1986; 20(1):56-62. Google Scholar4. Sebai ZA. The health of the family in a changing Arabia. Jeddah: Tihama Publications; 1983. Google Scholar5. Fysh J. Congenital dislocation of the hip - why so common, so severe? Proc Symposium on clinical neonatologyTabukNovember 198661. Google Scholar6. Kaushal V, Kaushal SP, Bhakoo ON. Congenital dysplasia of the hip in Northern India . International Surgery. 1976; 61(1):29-30. Google Scholar7. Kaushal V, Kaushal SP, Bhakoo ON. Congenital dysplasia of the hip in Northern IndiaBull of Postgraduate Institute, Chandigarth, India, 1972; 6:20-2. Google Scholar8. Fredensborg N. Observations in children with congenital dislocation of the hip . Acta Orthop Scand. 1976; 47(2):175-80. Google Scholar9. Fredensborg N. The effect of early diagnosis of congenital dislocation of the hip . Acta Pediatr Scand. 1976; 65(3):323-8. Google Scholar10. Palmen K. Prevention of congenital dislocation of the hip: the Swedish experience of neonatal treatment of hip joint instability . Acta Orthop Scand. 1984; 208(suppl):1-107. Google Scholar11. Suzuki S, Yamamuro T. Correlation of fetal posture and congenital dislocation of the hip . Acta Orthop Scand. 1986; 57(1):81-4. Google Scholar12. Mufti MH. Prime factors in the etiology of congenital dislocation of the hip and talipes equinovarus in Riyadh . Ann Saudi Med. 1988; 8(1):29-34. Google Scholar13. David TJ, Parris MR, Poynor MY, et al. Reasons for late detection of hip dislocation in childhood . Lancet. 1983; 2(8342):147-9. Google Scholar14. Allen RP. Ischemic necrosis following treatment of hip dysplasia . J Am Med Asso. 1962; 180:497-9. Google Scholar15. Fredensborg N, Nilsson BE. Overdiagnosis of congenital dislocation of the hip . Clin Orthop. 1976; 119:89-92. Google Scholar Previous article Next article FiguresReferencesRelatedDetailsCited byMoussa M and Alumran A (2019) Re: The adult hip joint in Saudi Arabia, Annals of Saudi Medicine , 27:2, (129-129), Online publication date: 1-Mar-2007. Volume 14, Issue 1January-February 1994 Metrics History Accepted3 April 1993Published online1 January 1994 AcknowledgmentThe author expresses his gratitude for the contribution of the Orthopedic Department; in particular, Prof. Ake Ahlberg for his dedication and support of this project.InformationCopyright © 1994, Annals of Saudi MedicineThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.PDF download" @default.
• W2413502308 created "2016-06-24" @default.
• W2413502308 creator A5053683097 @default.
• W2413502308 date "1994-01-01" @default.
• W2413502308 modified "2023-10-10" @default.
• W2413502308 title "Neonatal Hip Instability in Saudi Arabia: Results And Cost Effectiveness" @default.
• W2413502308 cites W1996048263 @default.
• W2413502308 cites W2012218383 @default.
• W2413502308 cites W2052203630 @default.
• W2413502308 cites W2095437079 @default.
• W2413502308 cites W2169157117 @default.
• W2413502308 cites W2612105339 @default.
• W2413502308 cites W2613660372 @default.
• W2413502308 doi "https://doi.org/10.5144/0256-4947.1994.16" @default.
• W2413502308 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/17589046" @default.
• W2413502308 hasPublicationYear "1994" @default.
• W2413502308 type Work @default.
• W2413502308 sameAs 2413502308 @default.
• W2413502308 citedByCount "4" @default.
• W2413502308 countsByYear W24135023082018 @default.
• W2413502308 crossrefType "journal-article" @default.
• W2413502308 hasAuthorship W2413502308A5053683097 @default.
• W2413502308 hasBestOaLocation W24135023081 @default.
• W2413502308 hasConcept C121332964 @default.
• W2413502308 hasConcept C187212893 @default.
• W2413502308 hasConcept C207821765 @default.
• W2413502308 hasConcept C57879066 @default.
• W2413502308 hasConcept C71924100 @default.
• W2413502308 hasConceptScore W2413502308C121332964 @default.
• W2413502308 hasConceptScore W2413502308C187212893 @default.
• W2413502308 hasConceptScore W2413502308C207821765 @default.
• W2413502308 hasConceptScore W2413502308C57879066 @default.
• W2413502308 hasConceptScore W2413502308C71924100 @default.
• W2413502308 hasIssue "1" @default.
• W2413502308 hasLocation W24135023081 @default.
• W2413502308 hasLocation W24135023082 @default.
• W2413502308 hasOpenAccess W2413502308 @default.
• W2413502308 hasPrimaryLocation W24135023081 @default.
• W2413502308 hasRelatedWork W1506200166 @default.
• W2413502308 hasRelatedWork W1995515455 @default.
• W2413502308 hasRelatedWork W2048182022 @default.
• W2413502308 hasRelatedWork W2080531066 @default.
• W2413502308 hasRelatedWork W2604872355 @default.
• W2413502308 hasRelatedWork W2748952813 @default.
• W2413502308 hasRelatedWork W2899084033 @default.
• W2413502308 hasRelatedWork W3031052312 @default.
• W2413502308 hasRelatedWork W3032375762 @default.
• W2413502308 hasRelatedWork W3108674512 @default.
• W2413502308 hasVolume "14" @default.
• W2413502308 isParatext "false" @default.
• W2413502308 isRetracted "false" @default.
• W2413502308 magId "2413502308" @default.
• W2413502308 workType "article" @default.