Background: Developmental dysplasia of the hip (DDH) is a common condition, affecting 1% to 2% of full-term infants. The American Academy of Orthopaedic Surgeons (AAOS) and American Academy of Pediatrics have published guidelines detailing best practices for DDH screening and treatment. The purpose of this survey was to determine DDH treatment practices of pediatric orthopaedic surgeons in North America. Methods: We queried orthopaedic surgeon members of the Pediatric Orthopaedic Society of North America (POSNA) about referral patterns, treatment practices, and use of DDH guidelines. The survey included demographics, clinical scenarios, referrals patterns, and ultrasound practices. Results: Of the 1392 members of POSNA, we received 432 total responses and included 353 in statistical analyses. Results show that 68% (233/342) of surgeons practice in an institution that does not endorse a standard care pathway for DDH. Of surgeons who personally use a DDH care pathway, the AAOS guidelines were most cited (143/353, 41%). The majority (94%, 316/337) of surgeons do not believe that universal ultrasound screening should be adopted in the United States. Responses regarding ultrasound screening for “high risk” infants as outlined by AAOS varied based on risk factor. Many (57%, 200/353) surgeons have performed initial evaluations for patients over 12 months of age. While 80% (260/327) of orthopaedic surgeons believe that primary care providers are referring patients appropriately, only 57% (183/323) believe that primary care providers are ordering imaging studies appropriately. Conclusions: Results from this survey of POSNA membership indicate an opportunity to better distribute and implement DDH guidelines. In addition, the implementation of a care map with a focus on standard referral and imaging practices could improve the care of patients with DDH by: (1) reducing the total cost of care, (2) increasing the use of appropriate imaging, (3) increasing timely referral for DDH care, and (4) reducing the presentation rate of walking age DDH patients. Level of Evidence: The level of evidence rating for this survey-based study is level IV.

Objective. Women with intellectual or developmental disabilities (IDDs) experience poorer prenatal care and worse perinatal health and birth outcomes than the general population. The purpose of this study is to describe the maternal characteristics and to identify factors associated with the increased risk of adverse birth outcomes among women with an IDD. Methods. Electronic medical records and the Utah Population Database were used to identify demographic and medical characteristics of pregnant individuals between 14 and 45 years old with an IDD and the related birth outcomes. Random-effects logistic regression was used to identify factors that were associated with adverse birth outcomes. Results. A total of 5147 births by 2250 mothers with an IDD (average births per mother = 2.33) were identified. Multigestational pregnancy (twins or triplets) (OR = 32.85, p < 0.01), fewer prenatal care visits (OR = 3.01, <0.01), gestational hypertension (OR = 2.74, p < 0.01), and the presence of a mental illness (OR = 1.28, p = 0.01) had an increased risk for preterm delivery. Associated low birth weight factors included multigestational pregnancy (OR = 22.82, p < 0.01), gestational hypertension (OR = 3.23, p < 0.01), maternal smoking status (OR = 1.54, p < 0.01), fewer prenatal visits (OR = 2.91, p < 0.01), and maternal mental health disorder (OR = 1.66, p < 0.01). Cesarean deliveries were associated with gestational hypertension (OR = 2.33, p < 0.01), Medicaid coverage (OR = 1.76, p < 0.01), and gestational diabetes (OR = 1.42, p < 0.01). Neonatal intensive care unit (NICU) admission was associated with increasing maternal age, multigestational pregnancy, the number of prenatal care visits, hypertension, and maternal mental disorders. Conclusions. These results suggest that sociodemographic factors and health problems put women with an IDD at a higher risk of adverse pregnancy and infant outcomes. Appropriate clinical care and social supports should be utilized to optimize the health and outcomes of this population.