NHS / PHE Guidelines for Management of DDH During the Covid 19 Pandemic

Government restrictions have been put in place in March 2020, limiting the movements of the public as a patient safety measure. It is accepted that during this crisis, routine non- urgent ultrasound scanning may not take place resulting in a delay for the scanning of unstable or at-risk hips. It may well not be possible to adhere to the present NIPE standards due to the government restrictions on movement, public gatherings and the treatment of non-urgent cases. Medical and sonographic personnel may also not be available. If screening is cancelled or postponed, a letter with contact details for patient queries should be drafted by the hip-screening department within the Trust.

Screen positive after clinical examination (suspected dislocated or dislocatable hip)

• In light of current pressure on all services, only babies with screen positive results on physical examination should be referred for hip ultrasound. As far as possible the recommended target times should be adhered to, but we recognise that this may not be possible and therefore the scan should be undertaken as soon as is reasonably feasible.
• If a maternity hospital has the capacity and experience, babies should receive the hip ultrasound prior to discharge from the hospital, where possible.
  • If the ultrasound is normal (centred hip and Graf >55 degrees) the child can be discharged.
  •  If the child has any abnormality, the child should be rescanned at 6 weeks of age. Treatment need not automatically begin at this stage, and parents should be reassured that many hips will resolve spontaneously. Parents should be advised not to swaddle their child. Commencing treatment early will increase unnecessary face-to-face follow-ups with its incumbent risks during the period of social distancing.
• If a maternity hospital does not have the capacity and/or experience, the child should be scanned at 6 weeks of age. If hip ultrasound is not possible 6 weeks of age the scan should be arranged as soon as possible when services resume.
• For those scanned at 6 weeks of age (for either of the above reasons), and the hip is found not normal (a normal hip is a centred hip and Graf >55 degrees), orthopaedic review will be required and a harness may be commenced. Once in a harness, treatment follows the standard harness protocol.

Screen positive for hip risk factors (i.e. Breech or Family History)

• Babies with hip risk factors who would usually have hip scan at 6 weeks of age should NOT be referred for hip ultrasound. This should be delayed until normal services resume when these children will be then followed up through clinical examination and/or ultrasound/ radiographic follow-up.
• Accurate records should be kept so that any babies who have missed out on a scan or orthopaedic opinion can be traced and followed up as appropriate, when resources permit. The screen positive result should be recorded on S4N to enable follow up at a later stage. In all cases where screening or follow up cannot be completed, records will remain as pending on S4N for later follow up.
• Referring babies with ‘clicky hips’ is not national policy so in line with current national guidance, babies with screening findings of ‘clicky hips’ should NOT receive hip ultrasound.