NEONATAL HIPS US - Paranormal Zone & Haunting Dimensions

Special thanks to the ultrasound, and to the peads sonographers at the University hospital In Saskatoon for their contribution.

ROLE OF ULTRASOUND

To ensure the correct development and stability of neonatal hips.

Common Indications

Clicky hip
Asymmetrical
creases
Family history congenital hip dysplasia/dislocation (9:1 F:M)
Breech lie during the pregnancy
Limited abduction
Deformities of the foot

LIMITATIONS

If the baby is greater than 6 months, the hips may be too ossified to examine adequately with ultrasound. If the baby is 12 months or greater and presents with symptoms, an Xray should also be performed.

EQUIPMENT SELECTION

This depends on the age and size of the child.
A 12Mhz linear array probe can be used for a newborn but as the child grows a 7MHz will be required to get adequate penetration. If the tri-radiate cartilage cannot be seen, you will need to decrease the frequency.
The scan can only be performed when the ossification of the proximal femoral epiphyses is not too far advanced.
A machine with cine capabilities and a foot switch is helpful as you can keep your hands on the baby to capture the correct image.

PATIENT PREPARATION

It is recommended that the most accurate time to scan the baby is over 6 weeks .This is because the hips are more mature and not lax. Otherwise false positives can occur as the baby’s hips initially have some natural laxity.

The nappy can be left on and just open the tabs on the side you are scanning to get access to the hip coronally.

The parent can stay with the child at all times to calm them.

SCANNING TECHNIQUE

The baby’s hip must be dynamically scanned with coronal and transverse evaluation with the hip in:

Neutral
abduction/adduction
Flexion with and without stress

PATIENT POSITION

There are numerous ways that you can scan the baby.

Lie the baby supine (Have the baby’s feet facing you).
The baby can lie decubitus with a pillow/towel rolled up at the back to give them support.
Using a specific ‘cradle’. *

*please note that we feel a cradle is not ideal to use as it does not allow movement of the baby’s leg to assess dislocation with stress in adduction ,abduction, flexion or extension.

THE GRAF CHD CLASSIFICATION

This method is adopted less commonly with the dynamic assessment and depth of coverage seen more favourable using modern equipment. A coronal view of the hip is obtained with:

The ilium horizontal.
A sharp, well defined acetbular roof.
A rounded femoral head.

Draw:

The baseline: along the ilium, through the femoral head.
The roof line: along the acetablular roof intersecting the baseline.
The inclination line: across the top of the femoral head, through the labrum and intersecting the 1st two lines.

ULTRASOUND CRITERIA

Subluxable: Yes/No

Laxity: Yes/No
Bony coverage of FCE : _____%

(most manufacturers have a %coverage calculator on the machine)

Alpha angle: ____ � Beta angle: ____ �
Acetabular Promontory: angular/rounded/flat

It can be performed on babies up to about 6 months of age.

Doctors order a hip ultrasound when they suspect a problem called developmental dysplasia of the hip (DDH). DDH is a hip deformity that can occur before, during, or weeks to months after birth.

In a normal-functioning hip, the femoral head rests comfortably in its socket. In babies with DDH, the femoral head moves back and forth within the socket; in more serious cases, it may move out of the socket, but can be put back into place with pressure — this is called dislocation. In the most severe cases, it may not be possible to put the femoral head into the socket at all.

The likelihood of DDH increases in these situations:

pregnancies in which the fetus is cramped in the uterus (due to a decrease in the amount of amniotic fluid, called oligohydramnios)
abnormal position of the baby in the womb (breech position)
babies with a family history of DDH

Also, DDH occurs more frequently in girls than boys and among first-born infants.

Doctors will consider all of these factors when deciding whether a baby’s hips should be checked by ultrasound. In addition, a baby will be sent for ultrasound if the doctor finds an abnormality of the hip during a physical examination, such as:

at birth, an inability to move the thigh outward at the hip as far as normally possible
a hip “click” heard or felt by the doctor when moving the infant’s thigh outward during a routine checkup
differences in the lengths or appearances of the infant’s legs

Preparation

Usually, you don’t have to do anything special to prepare your baby for a hip ultrasound. You should tell the technician about any medications your baby is taking before the test begins.

Procedure

The hip ultrasound usually will be done in the radiology department of a hospital or in a radiology center. Parents usually can accompany their child to provide reassurance and support.

You’ll be asked to partly undress your baby and to remove the diaper for the test. Your baby will be placed on a table on his or her back or side. The room is usually dark so the images can be seen clearly on the computer screen.

A technician (sonographer) trained in ultrasound imaging will spread a clear, gel on the skin of the hip. This gel helps with the transmission of the sound waves. The technician will then move a small wand (transducer) over the gel. The transducer emits high-frequency sound waves and a computer measures how the sound waves bounce back from the body. The computer changes those sound waves into images to be analyzed.

Sometimes a doctor will come in at the end of the test to meet your baby and take a few more pictures. The procedure usually takes about 20 minutes. Both hips are usually examined.

The hip ultrasound is painless. Your baby may feel a slight pressure on the hip as the transducer is moved, and the gel may feel wet or cold.

It might be helpful to feed your baby just before the ultrasound to make him or her more relaxed. If you’re present during the test, comfort your baby with a calm and soothing voice or sing a favorite song. Make sure to stand where he or she can see your face.

please see this You tube for peads hips and spine ultrasound

https://www.youtube.com/watch?v=T57sN3SGAes

Thank you For reading

Steve Ramsey; Calgary, Alberta- Canada.