ABSTRACT
OBJECTIVE: Since it is difficult to identify women at increased risk of fetal brachial plexus birth palsy (BPBP) during labor and delivery, we aimed to construct and validate a risk score. METHODS: A retrospective case-control study was undertaken in 2001 and 2006 in an urban context in Malmö, Sweden. A risk score was constructed for all women who had received routine municipal maternal health care at Skåne University Hospital (n = 10 459). The model was validated among all pregnant women with BPBP and controls in Sweden between 2006 and 2007. RESULTS: The likelihood of BPBP increased as the risk score rose: 3.1% of the women studied had a risk score ≥5, including 32.1% of the BPBP cases, where the risk showed a 38-fold increase, as compared to those with a risk score ≤1 (2/3 of the population). CONCLUSION: Our findings indicate that it is possible to identify women at increased risk of having a child with BPBP by using variables observable in advance of delivery.
Subject(s)
Brachial Plexus Neuropathies/diagnosis , Decision Support Techniques , Paralysis, Obstetric/diagnosis , Prenatal Care , Brachial Plexus Neuropathies/etiology , Case-Control Studies , Female , Humans , Infant, Newborn , Logistic Models , Multivariate Analysis , Odds Ratio , Paralysis, Obstetric/etiology , Pregnancy , Reproducibility of Results , Retrospective Studies , Risk Assessment , Risk FactorsABSTRACT
AIM: To relate pregnancy characteristics to extent and reversibility of brachial plexus birth palsy (BPBP) in neonates. METHODS: Retrospective case-control study: newborns with a registered diagnosis of BPBP (n = 168) 1990-2005 were compared to data from a randomly selected control group (n = 1000). Characteristics were related to the level of injury, reversibility and outcome. RESULTS: Among 51,841 newborns, 168 cases with BPBP were found (incidence 3.2/1000 newborns/year). Extent and reversibility of lesion did not differ with respect to characteristics of mothers, foetuses or deliveries. Children with C5-C6 and C5-C6-C7 injuries had complete recovery in 86% and 38%, respectively. Global injuries (C5-Th1) always had permanent disability. Accelerators (foetal weight gain >35 g/day after 32 weeks of gestation) and foetuses with estimated weight deviation ≥ +22% at 32 weeks were at seven- and ninefold increased risk of BPBP. Parous women were at doubled risk as compared to nulliparous women. CONCLUSION: Maternal and foetal characteristics influence risk of BPBP, but not the extent of injury or reversibility of injury. Because of the high risk of permanent disability and modest risk of low Apgar or pH among newborns with BPBP, the recommendation of prompt delivery may need to be re-evaluated.
Subject(s)
Birth Injuries , Brachial Plexus Neuropathies , Birth Injuries/diagnosis , Birth Injuries/therapy , Brachial Plexus Neuropathies/diagnosis , Brachial Plexus Neuropathies/therapy , Case-Control Studies , Humans , Infant, Newborn , Retrospective StudiesABSTRACT
Two neonates with proximal dorsal swelling and skin necrosis had median, ulnar, and particularly radial nerve palsies after birth, which was interpreted as compartment syndrome in the forearm. The swelling in case 1 disappeared, the skin lesion in case 2 healed, and the functions of nerves recovered almost completely in both cases, although the forearm and hand in the second patient were shorter and thinner than the contralateral side.
Subject(s)
Compartment Syndromes/diagnosis , Forearm/blood supply , Female , Forearm/innervation , Humans , Infant, Newborn , Male , Necrosis , Recovery of Function , Remission, Spontaneous , Skin/pathologyABSTRACT
BACKGROUND: Posterior dislocation of the shoulder in brachial plexus birth palsy during the first year of life is rare but the incidence increases with age. The aim was to calculate the incidence of these lesions in children below one year of age. METHODS: The incidence of brachial plexus birth lesion and occurrence of posterior shoulder dislocation was calculated based on a prospective follow up of all brachial plexus patients at an age below one in Malmö municipality, Sweden, 2000-2005. RESULTS: The incidence of brachial plexus birth palsy was 3.8/1000 living infants and year with a corresponding incidence of posterior shoulder dislocation (history, clinical examination and x-ray) during the first year of 0.28/1000 living infants and year, i.e. 7.3% of all brachial plexus birth palsies. CONCLUSION: All children with a brachial plexus birth lesion (incidence 3.8 per thousand) should be screened, above the assessment of neurological recovery, during the first year of life for posterior dislocation of the shoulder (incidence 0.28 per thousand) since such a condition may occur in 7% of children with a brachial plexus birth lesion.
