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HIQA Publishes Findings on Ultrasound Screening for Hip Dysplasia in Irish Infants

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The Health Information and Quality Authority (HIQA) in Ireland has recently released an evidence review concerning the use of universal ultrasound screening for developmental dysplasia of the hip (DDH) in infants. Commissioned by the National Screening Advisory Committee (NSAC), this review delves into the current practices and effectiveness of such screenings, aiming to inform and possibly reshape national health screening strategies. The report assesses whether implementing a universal ultrasound screening program across Ireland could lead to better health outcomes compared to the current selective ultrasound screening processes.

It examines data and case studies from other countries where universal ultrasound screening has been implemented, offering a global perspective on potential benefits and drawbacks. Additionally, the review considers the long-term healthcare cost implications of early DDH detection versus the costs associated with treating advanced cases that were not caught at an early stage. This comprehensive evaluation by HIQA is intended to provide a robust foundation for policymakers to decide on the most effective screening approach. Furthermore, it highlights the importance of early intervention in preventing severe complications that can lead to surgeries and other intensive treatments later in life.

Evaluating Universal vs. Selective Ultrasound Screening for DDH in Irish Infants

DDH is a congenital condition where the hip joint does not develop properly, potentially leading to pain, mobility issues, and severe long-term health problems like osteoarthritis and the need for hip replacements. Traditionally, physical examinations after birth check for signs of DDH, but not all cases are detectable this way. Ultrasound screenings can provide a more definitive diagnosis early on. Currently, Ireland does not have a universal screening program; instead, ultrasound screenings are performed selectively on infants identified at higher risk based on factors like gender, birth order, and birthing conditions.

The report from HIQA scrutinizes the advantages of universal ultrasound screening—where every infant would be screened—versus selective screening. However, the evidence, largely based on older studies, remains inconclusive, with some suggesting that universal screening might lead to unnecessary treatments for children who do not require them.

Despite recommendations made in 2017 for a selective ultrasound screening program, it is unclear how widely these have been implemented across Irish hospitals. HIQA suggests that a better grasp of how DDH is currently identified and managed could aid in the effective execution of these guidelines. Such a program would include comprehensive oversight, end-to-end care, and thorough monitoring of outcomes to ensure effectiveness and safety.

Ultrasound Screening

Discussing the Challenges and International Variations in Ultrasound Screening Practices

Dr. Máirín Ryan, Deputy CEO and Director of Health Technology Assessment (HTA) at HIQA, emphasized the limitations of the current evidence, stating that it does not support a definitive conclusion on the benefits of transitioning to a universal screening model. The ongoing uncertainty points to the need for further research and data collection to make informed decisions that could potentially enhance infant health outcomes nationwide.

The review also highlighted how DDH screening practices vary internationally, with countries like Austria and Germany implementing universal screening, while most others adhere to selective screening based on specific risk factors and clinical signs. Treatment protocols aim to correctly align the hip joint early in life to prevent future complications, with methods ranging from non-invasive harnesses in younger infants to surgical interventions in more severe cases.

As HIQA continues to evaluate and update its recommendations, the health authority remains committed to refining healthcare strategies to better address the needs of infants at risk of DDH in Ireland, aligning with international best practices and advancements in medical screenings.

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Resource: Health Information and Quality Authority, May 10, 2024

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