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Background <p>Traditional paradigms classify prematurity and multiple gestation as risk factors for developmental dysplasia of the hip (DDH). However, recent evidence suggests prematurity may reduce DDH risk via reduced intrauterine mechanical stress.</p> Objective <p>To examine whether prematurity and multiple gestation are independently associated with acetabular morphology in infants referred for Graf ultrasonography.</p> Materials and methods <p>This retrospective cohort study included 5,255 infants (1,230 preterm, 4,025 term) referred for hip ultrasonography from three clinical sources (neonatal ward, child health outpatient clinic, and paediatric orthopaedic clinic) between January 2022 and October 2024. Infants with genetic syndromes, neuromuscular diseases, or congenital malformations were excluded. Abnormal acetabular morphology was defined as Graf ≥IIb using standardised techniques. Three nested multivariable logistic regression models were adjusted for prematurity, sex, multiple gestation, foetal presentation, and delivery mode. Sensitivity analyses verified robustness.</p> Results <p>Abnormal acetabular morphology frequency was lower in preterm versus term infants (13.3% vs 28.9%, <i>P</i>&lt;0.001), with a dose-response across gestational ages. Hip <i>α</i>-angles showed a decreasing trend with increasing gestational age (Kendall’s <i>τ</i>=-0.10, <i>P</i>&lt;0.001), independent of chronological age at examination (<i>P</i>=0.21). In multivariable analysis (<i>n</i>=5,201), prematurity was associated with lower DDH odds (adjusted OR=0.45, 95% confidence interval (CI) 0.37–0.54), female sex was associated with higher odds (aOR=2.74, 95% CI 2.37–3.17), and multiple gestation showed no association (aOR=0.81, 95% CI 0.53–1.23).</p> Conclusions <p>Preterm birth showed lower abnormal acetabular morphology, while multiple gestation showed no independent association. Within referral settings, prematurity alone may not warrant routine DDH screening; population-based prospective studies are needed to confirm these findings.</p> Graphical abstract <p></p>

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Prematurity and acetabular morphology on Graf ultrasonography: a retrospective analysis of 5,255 infants referred for hip screening

  • 期刊论文

  • 发表日期：

    2026年5月12日

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  • Huan Xiao,
  • Zhilin Wu,
  • Xiaoling Liu,
  • Yuxi Su

摘要

Background

Traditional paradigms classify prematurity and multiple gestation as risk factors for developmental dysplasia of the hip (DDH). However, recent evidence suggests prematurity may reduce DDH risk via reduced intrauterine mechanical stress.

Objective

To examine whether prematurity and multiple gestation are independently associated with acetabular morphology in infants referred for Graf ultrasonography.

Materials and methods

This retrospective cohort study included 5,255 infants (1,230 preterm, 4,025 term) referred for hip ultrasonography from three clinical sources (neonatal ward, child health outpatient clinic, and paediatric orthopaedic clinic) between January 2022 and October 2024. Infants with genetic syndromes, neuromuscular diseases, or congenital malformations were excluded. Abnormal acetabular morphology was defined as Graf ≥IIb using standardised techniques. Three nested multivariable logistic regression models were adjusted for prematurity, sex, multiple gestation, foetal presentation, and delivery mode. Sensitivity analyses verified robustness.

Results

Abnormal acetabular morphology frequency was lower in preterm versus term infants (13.3% vs 28.9%, P<0.001), with a dose-response across gestational ages. Hip α-angles showed a decreasing trend with increasing gestational age (Kendall’s τ=-0.10, P<0.001), independent of chronological age at examination (P=0.21). In multivariable analysis (n=5,201), prematurity was associated with lower DDH odds (adjusted OR=0.45, 95% confidence interval (CI) 0.37–0.54), female sex was associated with higher odds (aOR=2.74, 95% CI 2.37–3.17), and multiple gestation showed no association (aOR=0.81, 95% CI 0.53–1.23).

Conclusions

Preterm birth showed lower abnormal acetabular morphology, while multiple gestation showed no independent association. Within referral settings, prematurity alone may not warrant routine DDH screening; population-based prospective studies are needed to confirm these findings.

Graphical abstract