Hoffer Alexander, Chhina Harpreet, Mulpuri Kishore, Cooper Anthony P
Faculty of Medicine.
Department of Orthopaedic Surgery, BC Children's Hospital Vancouver.
J Pediatr Orthop. 2023 Jan 1;43(1):e30-e35. doi: 10.1097/BPO.0000000000002274. Epub 2022 Oct 3.
The outcomes of Pavlik Harness (PH) management for Developmental Dysplasia of the Hip (DDH) are equivalent regardless of the initiation timing, if it is within the first 6 weeks of life. A PH may be a physical barrier to breastfeeding, which is important for nutrition, immunity, and normal child development. The diagnosis of DDH and early management with a PH may also negatively affect the maternal psychosocial wellbeing and the infant-maternal relationship. The purpose of this study is to investigate the impact of the diagnosis of DDH and the management with a PH has on maternal wellbeing and maintenance of breastfeeding, compared with being screened for but not diagnosed with DDH.
A retrospective cohort of the mothers of infants who were diagnosed with DDH and treated with a PH brace was compared with the mothers of infants who were screened for DDH only. The Hip Worries Inventory and Edinburgh Postnatal Depression Scale were completed by the mothers in both groups. The PH group also completed an in-house questionnaire specific to PH and breastfeeding.
Eighty completed surveys were included, 50 from the treatment group. The mean age of the PH initiation was 6.2 weeks. The modified Hip Worries Inventory score was higher in the treatment group, with a mean difference (MD) of 9.7 out of 50 (95% confidence interval, CI, 6.8, 12.5). The MD of the Edinburgh Postnatal Depression Scale was 2.0 out of 30 (CI -0.5, 4.5). Although there was no difference in the breastfeeding ease before and after the PH initiation (MD-0.2, CI-0.7, 0.2), 83% of mothers found breastfeeding more difficult with a PH and 11% of mothers stopped breastfeeding earlier than planned because of the PH.
Mothers of infants with DDH worry more about their child's hips and the PH. Screening alone may contribute to maternal psychological dejection and negative thoughts. The presence of a PH makes breastfeeding more difficult.
Retrospective comparative study, level III.
对于发育性髋关节发育不良（DDH），若在出生后6周内开始使用 Pavlik 吊带（PH）进行治疗，无论起始时间如何，治疗效果都是等同的。PH 可能会成为母乳喂养的物理障碍，而母乳喂养对营养、免疫及儿童正常发育都很重要。DDH 的诊断及早期使用 PH 治疗也可能对母亲的心理社会幸福感及母婴关系产生负面影响。本研究的目的是探讨与仅接受 DDH 筛查但未被诊断的情况相比，DDH 的诊断及使用 PH 治疗对母亲幸福感及母乳喂养维持情况的影响。
将诊断为 DDH 并使用 PH 支具治疗的婴儿的母亲组成的回顾性队列与仅接受 DDH 筛查的婴儿的母亲进行比较。两组母亲均完成了髋关节担忧量表和爱丁堡产后抑郁量表。PH 组还完成了一份针对 PH 和母乳喂养的内部问卷。
共纳入80份完整调查问卷，其中治疗组50份。开始使用 PH 的平均年龄为6.2周。治疗组改良髋关节担忧量表得分更高，平均差异（MD）为50分中的9.7分（95%置信区间，CI，6.8，12.5）。爱丁堡产后抑郁量表的 MD 为30分中的2.0分（CI -0.5，4.5）。虽然开始使用 PH 前后母乳喂养的难易程度没有差异（MD -0.2，CI -0.7，0.2），但83%的母亲发现使用 PH 时母乳喂养更困难，11%的母亲因 PH 比计划更早停止母乳喂养。
DDH 婴儿的母亲更担心孩子的髋关节及 PH。仅筛查可能会导致母亲心理沮丧和消极想法。PH 的存在使母乳喂养更加困难。
回顾性比较研究，III级。
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