ArticleEClinicalMedicine2025
Optimizing early hip maturation strategies in neonatal hip immaturity and dysplasia: a cohort study and network meta-analysis.
Article in EClinicalMedicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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15 authors.
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Abstract
Background: Early intervention is crucial for optimizing hip maturation in developmental dysplasia of the hip (DDH). This study evaluates the clinical effectiveness of various conservative management approaches. Methods: We employed a dual-approach methodology combining original research with systematic evidence synthesis. First, we conducted a prospectively-designed retrospective cohort study from January 2021 to December 2023, comparing three treatment approaches in 103 hips: Pavlik harness (n = 35), double diapering (n = 39), and observation (n = 29), with 12-month follow-up. Second, we performed a network meta-analysis (NMA) registered in PROSPERO (CRD42024591239) to synthesize broader evidence on treatment effectiveness. We systematically searched MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials from inception to April 15, 2025, without language restrictions. The NMA included 9 studies (6 randomized, 3 non-randomized) encompassing 681 hips and compared five interventions: dynamic splinting (with/without sequential weaning), static splinting, observation, double diapering, and Mongolian swaddling. Primary outcomes were alpha angle improvement and normalization rates; secondary outcomes included treatment switching and adverse events. Findings: Pavlik harness showed superior one-month improvements in alpha angle (11.0° ± 5.1° versus 8.5° ± 2.9° versus 5.4° ± 4.5°, Interpretation: Both dynamic splinting and double diapering effectively promote hip maturation in cases of hip immaturity (Graf IIa), with dynamic splinting producing more rapid improvements. For both immature and dysplastic hips (all Graf ≥ IIa), dynamic splinting appears to be the most effective treatment overall, while double diapering offers a viable alternative. Funding: This study was supported by grants from the National Science and Technology Council (NSTC 113-2314-B-006-090-, awarded to Chien-An Shih; NSTC 113-2314-B-006-085- and NSTC 113-2640-B-006-004-, awarded to Kai-Lan Hsu) and National Cheng Kung University Hospital (NCKUH-11404024, awarded to Chien-An Shih; NCKUH-11402044, awarded to Kai-Lan Hsu).
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