{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:37:37Z","timestamp":1791999457323,"version":"4.4.0"},"reference-count":24,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T00:00:00Z","timestamp":1685404800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Developmental dysplasia of the hip (DDH) is a progressive condition that lacks clear diagnostic and management protocols, due to insufficient data. While some advocate for universal screening, others recommend using risk factors as landmarks. In this study, we aimed to assess the risk factors associated with DDH incidence among a large population. We conducted a retrospective single-center multifactorial study between January 2019 and March 2022, including 3720 children who were investigated anamnestically, clinically, and through an ultrasound scan. We classified them into two groups: the control group with 3300 healthy children and the study group with 420 newborns diagnosed with DDH. Our analysis identified several risk factors associated with DDH, including gender, prematurity, non-vertex birth presentation, oligohydramnios, gestational diabetes, maternal hypertension, family history, associated deformities, and swaddling. We found that every DDH patient had at least two risk factors. Based on our findings, we recommend that children who present two or more risk factors for DDH be mandatorily evaluated sonographically, as well as children with clinical signs. DDH screening is recommended for each newborn for the long-term benefits of early detection and treatment.<\/jats:p>","DOI":"10.3390\/children10060968","type":"journal-article","created":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T02:33:27Z","timestamp":1685414007000},"page":"968","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Developmental Dysplasia of the Hip: How Many Risk Factors Are Needed?"],"prefix":"10.3390","volume":"10","author":[{"given":"Adelina","family":"Ionescu","sequence":"first","affiliation":[{"name":"Pediatric Orthopedics Department, \u201cGrigore Alexandrescu\u201d Children\u2019s Emergency Hospital, 011743 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai-Codrut","family":"Dragomirescu","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics Department, \u201cGrigore Alexandrescu\u201d Children\u2019s Emergency Hospital, 011743 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6697-2561","authenticated-orcid":false,"given":"Alexandru","family":"Herdea","sequence":"additional","affiliation":[{"name":"11th Department of Pediatric Orthopedics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, Bd. Eroii Sanitari nr. 8, 050474 Bucharest, Romania"},{"name":"Pediatric Orthopedics Department, \u201cGrigore Alexandrescu\u201d Children\u2019s Emergency Hospital, 011743 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1018-1506","authenticated-orcid":false,"given":"Alexandru","family":"Ulici","sequence":"additional","affiliation":[{"name":"11th Department of Pediatric Orthopedics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, Bd. Eroii Sanitari nr. 8, 050474 Bucharest, Romania"},{"name":"Pediatric Orthopedics Department, \u201cGrigore Alexandrescu\u201d Children\u2019s Emergency Hospital, 011743 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,30]]},"reference":[{"key":"ref_1","unstructured":"Nandhagopal, T., and Cicco, F.L.D. (2022, January 16). 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(SICOT)"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.12968\/hmed.2020.0476","article-title":"Developmental dysplasia of the hip","volume":"81","author":"Zhang","year":"2020","journal-title":"Br. J. Hosp. Med."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Laliotis, N., and Konstandinidis, P. (2023). Concentric Circles: A New Ultrasonographic Sign for the Diagnosis of Normal Infantile Hip Development. Children, 15.","DOI":"10.3390\/children10010168"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"147","DOI":"10.15557\/JoU.2021.0024","article-title":"Ultrasound of the neonatal hip as a screening tool for DDH: How to screen and differences in screening programs between European countries","volume":"21","author":"Kilsdonk","year":"2021","journal-title":"J. Ultrason"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1097\/00013644-200412000-00005","article-title":"Sonography of Hip Dysplasia","volume":"20","author":"Smergel","year":"2004","journal-title":"Ultrasound Q."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1007\/s11832-016-0798-5","article-title":"Epidemiology of developmental dysplasia of the hip within the UK: Refining the risk factors","volume":"10","author":"Woodacre","year":"2016","journal-title":"J. Child. Orthop."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1007\/s00431-017-2959-z","article-title":"Diagnosing developmental dysplasia of the hip using the Graf ultrasound method: Risk and protective factor analysis in 11,820 universally screened newborns","volume":"176","author":"Schams","year":"2017","journal-title":"Eur. J. Pediatr."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"American Academy of Pediatrics (2000). 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News"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/s11832-012-0476-1","article-title":"Ultrasonographic Graf type IIa hip needs more consideration in newborn girls","volume":"7","year":"2013","journal-title":"J. Child. Orthop."},{"key":"ref_24","first-page":"427","article-title":"Treatment of Graf Type IIa Hip Dysplasia: A Cutoff Value for Decision Making","volume":"35","author":"Bilgili","year":"2018","journal-title":"Balkan Med. J."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/6\/968\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:44:53Z","timestamp":1760125493000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/6\/968"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,30]]},"references-count":24,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["children10060968"],"URL":"https:\/\/doi.org\/10.3390\/children10060968","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,30]]}}}