Are there modifiable risk factors that may predict the occurrence of brachial plexus injury?

Zuarez-Easton, Sivan; Zafran, Noah; Garmi, Gali; Nachum, Zohar; Salim, Raed

doi:10.1038/jp.2014.215

Cited by 9 publications

(18 citation statements)

References 24 publications

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“…(Gestational) diabetes as a risk factor with an odds ratio of 5.33 (95% CI 3.77–7.55; I 2 =59%; n =1 651 281) was explored in 10 studies (Fig. S3c).…”

Section: Resultsmentioning

confidence: 99%

“…The characteristics of the 22 included articles are listed in Table S2 (online supporting information). Twelve were cohort studies and 10 were case–control studies . Only four studies had a prospective design .…”

Section: Resultsmentioning

confidence: 99%

“…Only four studies had a prospective design . Nine studies were conducted in Europe, seven in North America, five in Asia, and one in Australia . The primary outcome in each study was risk factors for NBPP.…”

Section: Resultsmentioning

confidence: 99%

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Risk factors for neonatal brachial plexus palsy: a systematic review and meta‐analysis

Looven

Roy

Tanghe

et al. 2019

Develop Med Child Neuro

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Aim To provide a comprehensive update on the most prevalent, significant risk factors for neonatal brachial plexus palsy (NBPP). Method Cochrane CENTRAL, MEDLINE, Web of Science, Embase, and ClinicalTrials.gov were searched for relevant publications up to March 2019. Studies assessing risk factors of NBPP in relation to typically developing comparison individuals were included. Meta‐analysis was performed for the five most significant risk factors, on the basis of the PRISMA statement and MOOSE guidelines. Pooled odds ratios (ORs), 95% confidence intervals (CIs), and across‐study heterogeneity (I2) were reported. Reporting bias and quality of evidence was rated. In addition, we assessed the incidence of NBPP. Results Twenty‐two observational studies with a total sample size of 29 419 037 live births were selected. Significant risk factors included shoulder dystocia (OR 115.27; 95% CI 81.35–163.35; I2=92%), macrosomia (OR 9.75; 95% CI 8.29–11.46; I2=70%), (gestational) diabetes (OR 5.33; 95% CI 3.77–7.55; I2=59%), instrumental delivery (OR 3.8; 95% CI 2.77–5.23; I2=77%), and breech delivery (OR 2.49; 95% CI 1.67–3.7; I2=70%). Caesarean section appeared as a protective factor (OR 0.13; 95% CI 0.11–0.16; I2=41%). The pooled overall incidence of NBPP was 1.74 per 1000 live births. It has decreased in recent years. Interpretation The incidence of NBPP is decreasing. Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are risk factors for NBPP. Caesarean section appears as a protective factor. What this paper adds The overall incidence of neonatal brachial plexus palsy is 1.74 per 1000 live births. The incidence has declined significantly. Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are the main risk factors. Prevention is difficult owing to unpredictability and often labour‐related risk.

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“…(Gestational) diabetes as a risk factor with an odds ratio of 5.33 (95% CI 3.77–7.55; I 2 =59%; n =1 651 281) was explored in 10 studies (Fig. S3c).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Risk factors for neonatal brachial plexus palsy: a systematic review and meta‐analysis

Looven

Roy

Tanghe

et al. 2019

Develop Med Child Neuro

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“…These include advanced maternal age, obesity, diabetes, abnormalities of second-stage labor, vacuum-or forceps-assisted delivery, and shoulder dystocia. 20,27,28,40,43 Factors that have been suggested to be protective against NBPP include twin or multiple births and cesarean delivery. 16 Though this wide range of factors has been suggested, none have been consistently shown to be predictive of NBPP occurrence.…”

Section: Discussionmentioning

confidence: 99%

Peripartum and neonatal factors associated with the persistence of neonatal brachial plexus palsy at 1 year: a review of 382 cases

Wilson

Chang

Chauhan

et al. 2016

PED

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OBJECTIVE Neonatal brachial plexus palsy (NBPP) occurs due to the stretching of the nerves of the brachial plexus before, during, or after delivery. NBPP can resolve spontaneously or become persistent. To determine if nerve surgery is indicated, predicting recovery is necessary but difficult. Historical attempts explored the association of recovery with only clinical and electrodiagnostic examinations. However, no data exist regarding the neonatal and peripartum factors associated with NBPP persistence. METHODS This retrospective cohort study involved all NBPP patients at the University of Michigan between 2005 and 2015. Peripartum and neonatal factors were assessed for their association with persistent NBPP at 1 year, as defined as the presence of musculoskeletal contractures or an active range of motion that deviated from normal by > 10° (shoulder, elbow, hand, and finger ranges of motion were recorded). Standard statistical methods were used. RESULTS Of 382 children with NBPP, 85% had persistent NBPP at 1 year. A wide range of neonatal and peripartum factors was explored. We found that cephalic presentation, induction or augmentation of labor, birth weight > 9 lbs, and the presence of Horner syndrome all significantly increased the odds of persistence at 1 year, while cesarean delivery and Narakas Grade I to II injury significantly reduced the odds of persistence. CONCLUSIONS Peripartum/neonatal factors were identified that significantly altered the odds of having persistent NBPP at 1 year. Combining these peripartum/neonatal factors with previously published clinical examination findings associated with persistence should allow the development of a prediction algorithm. The implementation of this algorithm may allow the earlier recognition of those cases likely to persist and thus enable earlier intervention, which may improve surgical outcomes.

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“…Other than the ACOG guidance, the prevailing position in obstetrics practice is that despite knowing the risk factors for shoulder dystocia, one cannot determine accurately enough when it will occur to justify avoiding vaginal delivery. 5 6 7 8 Importantly, none of these references examined a risk assessment based on combinations of maternal and fetal size and shape, or sought to determine if those with persistent injury were also unpredictable.…”

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confidence: 99%

A Study of the Diagnostic Accuracy of an Existing Multivariable Test to Predict Shoulder Dystocia

Easley

Beste

2019

AJP Rep

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Objectives To evaluate the diagnostic accuracy of a multivariable prediction model, the Shoulder Screen (Perigen, Inc.), and compare it with the American College of Obstetricians and Gynecologists (ACOG) guidelines to prevent harm from shoulder dystocia. Study Design The model was applied to two groups of 199 patients each who delivered during a 4-year period. One group experienced shoulder dystocia and the other group delivered without shoulder dystocia. The model's accuracy was analyzed. The performance of the model was compared with the ACOG guideline. Results The sensitivity, specificity, positive, and negative predictive values of the model were 23.1, 99.5, 97.9, and 56.4%, respectively. The sensitivity of the ACOG guideline was 10.1%. The false-positive rate of the model was 0.5%. The accuracy of the model was 61.3%. Conclusion A multivariable prediction model can predict shoulder dystocia and is more accurate than ACOG guidelines.

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Are there modifiable risk factors that may predict the occurrence of brachial plexus injury?

Abstract: The findings suggest that very few factors contributing to brachial plexus injury are modifiable. For that reason, it remains an unpredictable and probably an unavoidable event.

Cited by 9 publications

References 24 publications

Risk factors for neonatal brachial plexus palsy: a systematic review and meta‐analysis

Risk factors for neonatal brachial plexus palsy: a systematic review and meta‐analysis

Peripartum and neonatal factors associated with the persistence of neonatal brachial plexus palsy at 1 year: a review of 382 cases

A Study of the Diagnostic Accuracy of an Existing Multivariable Test to Predict Shoulder Dystocia

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