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Twenty-first century parents want to be assured that their newborn infant is ‘normal’. But how reliable is the routine newborn examination procedure? Should parents trust us as health professionals when we say, or imply, that they have a normal, healthy infant? Do we have the competencies to declare ‘normality’?
The paper by McAllister et al1 on the identification of congenital dislocation of the hip (CDH) and developmental dysplasia of the hip (DDH) in the newborn is not reassuring. They compared data from 12 areas in Scotland, where ‘standard’ practice continued throughout the study period, with data from two ‘intervention’ areas employing a professional with specific responsibility for early identification of hip disorders in the newborn. The professional in one area was a ‘physician with an interest in DDH’ and an ‘extended scope physiotherapist’ in the other. The authors do not elaborate on these appointments nor do they specify exactly what these dedicated professionals did. In their two ‘intervention’ areas, they reduced the late surgery rate for hip disorders to 0.54/1000, but in the rest of Scotland the rate remained steady at 1.3/1000. This result is broadly in agreement with other successful interventions involving experienced paediatricians, orthopaedic surgeons, physiotherapists or advanced nurse practitioners.
There is a general agreement that early detection and treatment of CDH is worthwhile. Ortolani described the examination procedure for CDH in 1937 and Barlow extended it in 1964. A screening programme based on the Ortolani-Barlow test was introduced in the UK half a century ago, so these Scottish results should cause our profession to hang its collective head in shame. And if many dislocated or dislocatable hips are …
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