Neonatal hip screening and neurological maturation
THE CONTEXT
Hip maneuvers assess instability or dislocation, while neurological examination evaluates neonatal responses and gestational maturation.
Developmental dysplasia of the hip
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Developmental dysplasia of the hip occurs in 1 of 800 live births and is more common in girls, infants with a family history, and infants delivered by breech.
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The Barlow maneuver attempts to dislocate an unstable hip. Test each hip separately, stabilize the pelvis, and flex and adduct the hip while applying posterior pressure.
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The Ortolani sign concerns an already dislocated hip. With the neonate supine, knees fully flexed, and hips flexed to a right angle, test each hip separately while stabilizing the pelvis.
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During the Ortolani maneuver, abduct the thigh and push the femoral head anteriorly. Reduction into the acetabulum produces a distinctly palpable clunk.
Neurological examination and Moro reflex
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Assess alertness, cranial nerves, motor and sensory systems, and neonatal reflexes.
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The Moro reflex consists of abduction and extension of the arms followed by adduction and flexion.
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An asymmetric Moro reflex may occur with brachial plexus injury; the illustrated right-sided Erb’s palsy has no movement of the affected upper limb.
Sensory and cranial nerve responses
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A consistent blink response to light is present by 26 weeks, and startle or blinking to loud noise occurs by 28 weeks.
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Neonates respond to cotton soaked in peppermint by 32 weeks. Fixation and following, tested with a fluffy red yarn ball, are well established by term.
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Normal sucking and swallowing indicate proper function of cranial nerves V, VII, IX, X, and XII.
Feeding coordination and motor tone
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Feeding requires coordinated sucking, swallowing, and breathing.
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Suck-swallow coordination for paladai feeding is present by 32 weeks. Coordination for breastfeeding occurs by 34 weeks, while perfect suck-swallow-breathing coordination develops only by 38 weeks.
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At 28 weeks, resistance to passive manipulation of all limbs is minimal.
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Distinct lower-limb flexor tone is appreciated by 32 weeks. Flexor tone is palpable in both upper and lower extremities by 36 weeks.