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Investigators from Chang Gung University, Taoyuan, Taiwan, conducted a prospective comparison study to assess the effectiveness of double-diapering in newborns noted to have immature hip development at birth. Study participants were neonates with Graf type IIa hip development on ultrasound. With the Graf classification system, hips with an alpha angle, defined as the angle between the acetabular roof and vertical cortex of the ilium, >60° (Graf type I), are classified as mature, and hips with an alpha angle 50° to 59° (Graf type IIa) are considered immature. Newborns with a positive Ortolani test and those with more immature hips on ultrasound were excluded. During a 12-month enrollment period at a single institution, eligible patients were assigned to double-or single-diapering based on day of the week of birth. A repeat ultrasound was obtained when study participants were 4 weeks old. Ultrasounds were repeated on a monthly basis for those failing to have Graf type I hips until they were 3 months old; at that point a Pavlik harness was prescribed. The primary outcome was development of bilateral Graf type I hips at 1 month, and secondary outcomes were alpha angle at 1 month of age and change in alpha angle from baseline. These outcomes were compared in infants assigned to double- or single-diapering.
During the study period, 993 newborns were evaluated with hip ultrasounds. Of these, 163 had Graf type IIa hips, and 70 were enrolled in the study, including 52 girls and 18 boys. There were 33 infants assigned to the double-diaper group and 37 to single-diapering. There were no significant differences between the treatment groups in percentage of females, gestational age (mean 38.6 and 38.5 weeks, respectively, for those in the double- and single-diapering groups), and alpha angle at birth. At 1 month, 28 (84.8%) and 20 (54.1%) patients assigned to double- or single-diapering, respectively, had improvement to bilateral Graf type I hips (P = 0.006). Mean alpha angles were 63.8 ± 3.0° for those assigned to double-diapering and 60.6 ± 5.3° for infants in the single-diapering group (P = 0.003); change from baseline alpha angle also was significantly greater for those in the double-diapering group (P = 0.011). By 3 months of age, all study patients had bilateral Graf type I hips except for 1 infant in the single-diapering group who was placed in a Pavlik harness.
The authors conclude that in newborns with immature hip development at birth (Graf type IIa), double-diapering enhanced hip maturation.
Drs Dubik and Hennrikus have disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
The position of the hip during the first few months of life can influence the...
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