Obstetric Brachial Plexus Palsy in Newborn Babies of Diabetic and Non-Diabetic Mothers

Abstract

Compared to non-diabetic mothers, diabetic mothers are known to deliver larger babies who are at higher risk for shoulder dystocia and obstetric brachial plexus palsy. The intrapartum forces applied during delivery of larger babies are expected to be higher. Hence, the chances of these babies for good spontaneous recovery are expected to be lower; and this is a generally believed hypothesis. The objective of this retrospective study was to compare obstetric brachial plexus palsy in newborn babies of diabetic and non-diabetic mothers. There were a total of 655 cases of obstetric palsy: 253 cases with diabetic mothers and 402 with non-diabetic mothers. The former were more likely to develop total palsy while the latter were more likely to develop extended Erb's palsy. Newborn babies of diabetic mothers had significantly larger birth weights than those of non-diabetic mothers regardless of the type of palsy. The rate of good spontaneous recovery of the motor power of the limb in the two groups was not significantly different except in total palsy cases for shoulder external rotation and elbow flexion where the recovery was significantly better in the diabetic group. It was concluded that the generally believed hypothesis is not correct if one compares the outcome in the diabetic and non-diabetic groups for each type of palsy.

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

“…Macrosomia is an important risk factor for instrumental delivery and increases the risk of Caesarean section. Most studies confirm the higher incidence of maternal obesity, macrosomia, disproportional fetal growth, abnormal labour, and shoulder dystocia among diabetic pregnancies . Other major risk factors for macrosomia are increased maternal age (>35y) and obesity, a positive history of previous macrosomia, prolonged pregnancy, and multiparity .…”

“…In all others, a trial of labour is recommended. This requires preparedness for operative delivery, shoulder dystocia, and newborn asphyxia . In the case of shoulder dystocia, the risk for severity of NBPP is critically linked to a timely recognition, and increases with the number and types of manoeuvres required .…”

Obstetric brachial plexus palsy: a population-based retrospective case-control study and medicolegal considerations

“…: 8.6, p < .03). As reported by Al-Qattan et al [21], who retrospectively compared OBPP in newborn babies of diabetic (253 cases) and nondiabetic mothers (402 cases), children of diabetic mothers were more prone to develop total palsy whereas children of non-diabetic mothers were more likely to develop extended Erb's palsy. It is interesting to note that babies of diabetic mothers showed significantly higher birth weight in comparison to those of non-diabetic mothers regardless of the type of palsy, whereas in our study the comparison between the birth-weight of OBPP without diabetes (18 cases) and the six cases of OBPP with diabetes (mellitus and gestational diabetes) was statistically not significant (p > .05): 3849 g ± 322.2 versus 3878.6 g ± 101.5, respectively.…”

The Prognostic Value of Concurrent Horner Syndrome in Extended Erb Obstetric Brachial Plexus Palsy

“…The above criteria for spontaneous recovery were set forth in the literature and have been used in several previous comparative studies. 8,9…”