26.7.08

Neonatal hip instability and risk of total hip replacement in young adulthood: follow-up of 2,218,596 newborns - Medical Birth Registry of Norway

Engesaeter IØ, Lie SA, Lehmann TG, Furnes O, Vollset SE, Engesaeter LB.

The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Unifob, Bergen. ingvild.engesater@student.uib.no

BACKGROUND AND PURPOSE: Dysplasia is probably the most common underlying condition in osteoarthritis of the hip, leading to total hip replacement (THR) in young adulthood. We investigated whether hip instability at birth predisposes to THR in young adulthood.
METHODS: Since 1967, all newborns in Norway have been screened for neonatal hip instability (NHI) and the results have been reported to the Medical Birth Registry of Norway (MBRN). In the period 1967-2004, 2,218,596 newborns were registered. From 1987 to 2004, 442 of these individuals had been reported to the Norwegian Arthroplasty Register (NAR) after undergoing total hip replacement (mean age 25 (12-36) years).
RESULTS: Neonatal hip instability was reported in 19,432 newborns (0.88%) in the MBRN; according to the NAR, they had a 2.6 (CI 1.4-4.8) times increased risk of THR in young adulthood compared to those without NHI. The absolute risk was low, however; only 57 (95% CI: 30-105) in 10(5) for patients with NHI compared to 20 (95% CI: 18-22) in 10(5) for those without registered hip pathology. Of the 442 patients with THR, 95 were operated because of osteoarthritis of the hip secondary to dysplasia, according to the surgeon's report. However, only 8 of these 95 patients had been reported to have hip instability at birth.
INTERPRETATION: Neonatal hip instability increases the risk of THR in young adulthood. Unexpectedly, only 8% of those who underwent THR due to dysplasia were reported to have unstable hips at birth. Our results indicate that clinical testing for NHI is insufficient as a screening method for dysplastic hips that require THR in young adulthood.
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No parece que el cribado neonatal de la displasia evolutiva de cadera sea muy sensible :-(
O quizás es que lo de displasia evolutiva de cadera (DEC) sea muy cierto y muchas de ellas se desarrollen después del nacimiento. O quizás que los casos detectados por nosotros no llegan a THR precisamente por el cribado correcto al nacimiento y durante el primer año y el consiguiente tratamiento precoz. (Me quedo con esta última, que es la más favorable ;-)

5.7.08

La USPSTF recomienda el cribado de hipoacusia de todos los recién nacidos

En este mes de julio de 2008 la U.S. Preventive Services Task Force (USPSTF), principal organización federal estadounidense dedicada al establecimiento de recomendaciones sobre actividades preventivas y de promoción de la salud, ha modificado su recomendación sobre cribado de la audición en los recién nacidos, proponiendo ahora el cribado universal (grado de recomendación B), cuando antes (1996) no encontraba pruebas suficientes a favor o en contra de realizarlo en todos los neonatos y sólo recomendaba el intento de detección precoz en determinados grupos de riesgo de padecer sordera. Este cambio de rumbo lo basa la USPSTF en la siguiente argumentación: (copio y pego)
Importance
Children with hearing loss have increased difficulties with verbal and nonverbal communication skills, increased behavioral problems, decreased psychosocial well-being, and lower educational attainment compared with children with normal hearing.
Detection
Because half of the children with hearing loss have no identifiable risk factors, universal screening (instead of targeted screening) has been proposed to detect children with permanent congenital hearing loss (PCHL). There is good evidence that newborn hearing screening testing is highly accurate and leads to earlier identification and treatment of infants with hearing loss.
Benefits of Detection and Early Treatment
Good-quality evidence shows that early detection improves language outcomes.
Harms of Detection and Early Treatment
There is limited evidence about the harms of screening, with conflicting research findings regarding anxiety associated with false-positive test results. There is limited information about the harms of treatment. Complications of cochlear implant surgery include increased risk of meningitis; however, the overall risks of complications of screening and treatment are estimated to be small.
USPSTF Assessment
The USPSTF concludes that there is moderate certainty that the net benefit of screening all newborn infants for hearing loss is moderate.

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(Teníamos razón ;-)