Rate of referral of breech infants for hip ultrasound: an audit cycle.

BACKGROUND: Infants with risk factors for developmental dysplasia of the hip (DDH) should have hip ultrasounds performed shortly after birth to detect and treat the condition at an early stage. Breech presentation is associated with increased risk of DDH. We embarked on an audit cycle to assess and improve our rate of referral of breech infants for hip ultrasound.

METHODS: Two retrospective audits (phases I and II) were carried out before, and after, the introduction of a new pro-forma which encouraged recognition of breech presentation at the time of the routine neonatal examination. Breech infants were identified from labour ward records. Multiple births and infants < 35 weeks gestation were excluded. Infants were considered to have been referred for ultrasound if the computer system at our affiliated children's hospital held a record of an ultrasound appointment.

RESULTS AND CONCLUSIONS: In phase I 56% of breech infants born in our hospital had been referred for hip ultrasound. In phase II the referral rate had risen to 76% (p = 0.034). We conclude that the change in practice was effective. Further improvement might be achieved by increasing staff awareness of risk factors for DDH and by enlisting the help of advanced neonatal nurse practitioners (ANNPs) in routine neonatal examinations.