A first-born female who was born in breech position has asymmetric skin folds on newborn exam. What is the likely diagnosis and potential treatment?

The likely diagnosis in this scenario is developmental dysplasia of the hip (DDH). This condition is characterized by abnormal hip joint development, which can range from instability to complete dislocation. The presence of asymmetric skin folds on the newborn exam often raises suspicion for this condition, especially in a first-born female who was delivered in the breech position—a known risk factor for DDH.

In cases of developmental dysplasia of the hip, especially when detected early, the Pavlik harness is a common and effective treatment. This harness helps to position the hip joint correctly and allows for normal development by keeping the hip in a flexed and abducted position. It is especially recommended when the dysplasia is diagnosed early and is not associated with severe dislocation.

Surgery is typically reserved for more severe cases or when conservative treatment does not yield results. Thus, the recommendation of using a Pavlik harness, particularly when the condition is detected as severe, aligns with current guidelines for the management of developmental dysplasia of the hip in infants. This approach is crucial for promoting normal hip joint development and preventing long-term complications related to hip morphology.