Brachial-plexus palsy in the newborn.

Jackson, Shlomo; Hoffer, M. Mark; Parrish, Nikki

doi:10.2106/00004623-198870080-00013

Cited by 146 publications

(61 citation statements)

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“…There was no statistical difference (P>0.05) in parity, sex of the infant, induction of labor, presentation, instrumental delivery, midwife or obstetrician delivery. Although other studies found multiparity to be a significant risk factor, 15,16 its high prevalence in our population was found equally in both groups. Although the association with high birthweight, cephalic presentation and dystocia was found in other studies, [15][16][17] the association with maternal diabetes was only reported in one other study, 16 and no previous reports have shown a correlation with fetal distress, meconium-stained liquor, neonatal depression, maternal perineal lacerations or episiotomy, factors that might indicate difficult labor and fetal hypoxic-ischemic compromise.…”

Section: Brachial Plexus Palsycontrasting

confidence: 83%

“…[13][14][15] The high incidence (13.8%) of maternal diabetes mellitus in our population (85% of which are gestational diabetes) and even more in mothers of affected infants (27.0%), as well as high parity (mean 5), could be important factors for that difference. The frequency we observed is close to the incidence of 3.6 per 1000 reported in developing countries, 16 where the incidence of multiparity was high and maternal diabetes was also found to be a risk factor.…”

Section: Brachial Plexus Palsymentioning

confidence: 87%

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Clavicle Fracture and Brachial Plexus Palsy in the Newborn: Risk Factors and Outcome

Narchi

Kulaylat²,

Ekuma-Nkama³

1996

Ann Saudi Med

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H Narchi, N Kulaylat, E Ekuma-Nkama, Clavicle Fracture and Brachial Plexus Palsy in the Newborn: Risk Factors and Outcome. 1996; 16(6): 707-710 Since first reported in 1764, brachial plexus palsy and fractured clavicle in the newborn have been the subject of many publications aiming at defining their causes and looking at their prognosis, with varied and sometimes conflicting findings. [1][2][3][4][5][6][7][8][9][10][11][12]18 We undertook this study in a primary care setting of a developing country, in a population with high parity and a high incidence of diabetes in pregnancy, aiming to determine the incidence of these injuries in infants born in our hospital, to identify possible risk factors in our population and to determine the prognosis for full recovery of affected babies. Material and MethodsThe study included all infants who were born at our medical center between January 1991 and December 1993. All neonates were examined by pediatricians soon after birth and prior to discharge home any time after the first 24 hours. Weakness of the upper extremity during examination was looked for and the type of palsy (upper or lower brachial plexus involvement) was defined; loss of continuity or tender swelling over the clavicle, presence or absence of Horner syndrome or phrenic nerve palsy were sought, and x-rays were carried out to rule out a fracture of the clavicle in all affected infants.All affected infants were regularly followed up at two weeks, one and two months, and thereafter as indicated. Some cases of fractured clavicle were diagnosed a few weeks after birth when a visible callus, often first noticed by the mother, was seen. In cases of brachial plexus palsy, parents were instructed to passively mobilize the infant's affected limb through a full range of motion several times a day. Affected infants who did not recover within six months were referred to the orthopedist or neurologist and physical therapist.Maternal and neonatal data were collected, and peripartum events were analyzed. For infants with brachial plexus palsy, the age of recovery of normal function on follow-up was sought.Data was compared between the affected population and the rest of the nonaffected infants over the same period of the study. The t-test was used to compare means and the corrected chi-squared test was used to compare proportions (Fisher's exact test for small values). Results Brachial Plexus PalsyOf the 8855 live births at our medical center during the period of the study, 37 infants were diagnosed to have brachial plexus palsy, giving an incidence of 4.17 per 1000 live births. Of these, there were 24 (64.8%) left, 13 (35.2%) right and no bilateral palsies. All were upper brachial plexus palsies (Erb's), four had associated homolateral fractured clavicle, and none had Horner syndrome or phrenic nerve palsy.There were 22 affected males (59.5%) and 15 females (40.5%). All but three infants were delivered vaginally (92%); one singleton and a set of twins were delivered by cesarean section for breech position. The average...

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Section: Brachial Plexus Palsycontrasting

confidence: 83%

Section: Brachial Plexus Palsymentioning

confidence: 87%

Clavicle Fracture and Brachial Plexus Palsy in the Newborn: Risk Factors and Outcome

Narchi

Kulaylat²,

Ekuma-Nkama³

1996

Ann Saudi Med

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“…The literature typically cites spontaneous recovery as 75-95% for NBPP [2][3][4][5]. However, more recent reports have indicated that only about two-thirds of infants have spontaneously recovery [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Prognosis following neonatal brachial plexus palsy: An evidence-based review

Foad

Mehlman

Foad

et al. 2009

Journal of Children's Orthopaedics

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Purpose The spontaneous recovery rate of neonatal brachial plexus palsy (NBPP) is often cited as 75-95%. However, recent reports have found the recovery rate to be much lower. The purpose of this study was to perform an evidence-based review aimed at summarizing the available English language information regarding prognosis following NBPP based on the Narakas classification. Methods A Medline database search was performed to identify articles that focused on the natural history, outcome, prognosis, or conservative treatment of neonatal brachial plexus birth injury from 1966 to 2006. Twentyfour articles were identified. The articles were graded according to the Oxford Evidence Based Grading Scale and data regarding sample size, follow up, study purpose, Narakas grouping, Mallet scale, and recovery of function at 3 and 6 months were extracted. Of the 24 articles, 11 were included for review. Data analysis included odds ratios and percent recovery. Results Of the 11 studies, only one was given a grade of a Level I study, three were given a grade of Level II, and seven were given a grade of Level IV. Sixty-four percent of infants classified as Narakas I and II had spontaneous recovery of biceps function at 3 months of age and only 9% of the Narakas III and IV group had recovery. Sixtyfive percent of the Narakas I and II group had complete recovery at 6 months of age and only 14% of the Narakas III and IV group had recovery. The odds of biceps recovery at 3 months of age for the Narakas I and II group was 19 times higher compared to the III and IV group. The odds of complete recovery were 11 times higher for the Narakas I and II group compared to the III and IV group. Conclusion The quality of the literature regarding the prognosis of neonatal brachial plexus injury is poor. Based on the Narakas classification, recovery better for NBPP classified as Narakas I and II.

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“…rachial plexus birth palsy occurs at a rate of 0.38 to 4.6 per 1000 live births [1][2][3][4][5] . Although full recovery has been reported in up to 92% of cases 6 , recent studies have reported more modest recovery rates of 66% to 80% 7,8 .…”

mentioning

confidence: 99%