Pathophysiologic Origins of Brachial Plexus Injury

Johnson, Grace; Denning, Stacie; Clark, Steven L.; Davidson, Christina

doi:10.1097/aog.0000000000004013

Cited by 16 publications

(13 citation statements)

References 19 publications

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“…The incidence of BPP among the neonates of diabetic women was similar (T1D: 2.2% of vaginal live births, GDM: 0.6% of vaginal live births), 7,11 and the total incidence of BPP was higher than previously described in the literature (0.11% to 0.16% of vaginal births). 2,23 ShD was the strongest risk factor associated with injury in all neonates irrespective of the diabetes status of the parturient, which is in line with the findings of previous studies. 6,22 Furthermore, the incidence of ShD was similar to that previously reported.…”

Section: Discussionsupporting

confidence: 91%

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Severe birth injuries in neonates and associated risk factors for injury in mothers with different types of diabetes in Finland

Kekki

Tihtonen

Salonen

et al. 2022

Intl J Gynecology & Obste

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In Finland, approximately 1.7% of live-born neonates are diagnosed with a birth injury. 1 Most of the injuries are transient, but severe injuries can cause permanent disability and have lifelong consequences.The incidence of severe birth injury, including cranial hemorrhage, central nervous system injury, skeletal or visceral injury, and brachial plexus palsy (BPP), is reported to be between 0.2% and 0.5% in live births, and is mainly associated with vaginal deliveries. 2,3 Since the incidence of birth injuries is low and a remarkable number of cases in

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Section: Discussionsupporting

confidence: 91%

“…Perhaps because of the low incidences of ShD and LGA, the injuries among the neonates of non‐diabetic women occurred less often concomitant with ShD or LGA than injuries associated with maternal diabetes. A similar relationship was also reported by Johnson et al 23 …”

Section: Discussionsupporting

confidence: 90%

Severe birth injuries in neonates and associated risk factors for injury in mothers with different types of diabetes in Finland

Kekki

Tihtonen

Salonen

et al. 2022

Intl J Gynecology & Obste

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“…The 7-year retrospective cohort study of NBPP found that, while the overall incidence is rare at the study institution (0.08%), the frequency of NBPP with shoulder dystocia versus NBPP without shoulder dystocia, and that of transient versus persistent NBPP, did not differ significantly over the time period of the study. Moreover, the low occurrence of NBPP did not further decrease over time, regardless of Taylor & Prout, 1907) the amount of clinician experience, training, or practice with simulation (Johnson et al, 2020).…”

Section: Nbpp With and Without Shoulder Dystocia From A Comparative And Evolutionary Perspectivementioning

confidence: 82%

“…Moreover, NBPP can be the end-result of shoulder dystocia. Even without shoulder dystocia, NBPP is known to occur (Backe et al, 2008;Gherman et al, 1999;Gurewitsch et al, 2006;Johnson et al, 2020;Torki et al, 2012); a recent retrospective cohort study of NBPP injury over a 7-year period found that of the 33 NBPP cases identified, 42% did not involve shoulder dystocia (Johnson et al, 2020). We propose that a potential risk factor for NBPP without shoulder dystocia results from the human neonate simply having to follow the tortuous course through the birth canal.…”

Section: Nbpp With and Without Shoulder Dystocia From A Comparative And Evolutionary Perspectivementioning

confidence: 84%

Risk factors for neonatal brachial plexus palsy attributed to anatomy, physiology, and evolution

et al. 2021

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The inherent variable anatomy of the neonate and the uniquely-shaped maternal birth canal that is associated with the evolution of human bipedalism constitute risk factors for neonatal brachial plexus palsy (NBPP). For example, those neonates with a prefixed brachial plexus (BP) are at greater risk of trauma due to lateral neck traction during delivery than those with a normal or postfixed BP. Compared to adults, neonates also have extremely large and heavy heads (high head: body ratio) set upon necks with muscles and ligaments that are weak and poorly developed. Accordingly, insufficient cranial stability can place large torques on the cervical spinal nerves. In addition, the pelvic changes necessary for habitual bipedal posture resulted in a uniquely-shaped, obstruction-filled, sinusoidal birth canal, requiring the human fetus to complete a complicated series of rotations to successfully traverse it. Furthermore, although there are many risk factors that are known to contribute to NBPP, the specific anatomy and physiology of the neonate, except for macrosomia, is not considered to be one of them. In fact, currently, the amount of lateral traction applied to the neck during delivery is the overwhelming legal factor that is used to evaluate whether a birth attendant is liable in cases of permanent NBPP. Here, we suggest that the specific anatomy and physiology of the neonate and mother, which are clearly not within the control of the birth attendant, should also be considered when assessing liability in cases of NBPP.

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“…Brachial plexus injuries can occur as a result of the force exerted by the delivery doctor in an attempt to resolve shoulder dystocia. Many reports of transient or persistent brachial plexus injury, including nerve root avulsions, occur both in vaginal delivery without shoulder dystocia and caesarean section [30], [31], [32].…”

Section: Definition and Pathophysiologymentioning

confidence: 99%

Brachial Plexus Injury: Recent Diagnosis and Management

Sumarwoto

Suroto

Mahyudin³

et al. 2021

Open Access Maced J Med Sci

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Brachial plexus injury is known to be one of the most serious upper limb injuries, causes paralysis of the upper limbs and changes in activity of daily living, with the consequence disruption of activity of daily living, socio-economic problems, depression, and hopelessness. Management must be done properly. The evaluation and examination consist of detailed anamnesis on chronological events, complete physical examination, imaging studies, and electrophysiology study. Management can be done nonsurgically and surgically. Knowledge of the history of injury, timing of surgery, priority in restoring function, and managing patient expectations are important concepts in treating patient with brachial plexus injury. Timing is a very important thing. The results of these interventions vary depending on several parameters. Recognizing the basic principles of managing brachial plexus injuries is indispensable for all clinicians who treat these injuries.

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Pathophysiologic Origins of Brachial Plexus Injury

Abstract: Personal or nonessential information may be redacted at the editor's discretion.

Cited by 16 publications

References 19 publications

Severe birth injuries in neonates and associated risk factors for injury in mothers with different types of diabetes in Finland

Severe birth injuries in neonates and associated risk factors for injury in mothers with different types of diabetes in Finland

Risk factors for neonatal brachial plexus palsy attributed to anatomy, physiology, and evolution

Brachial Plexus Injury: Recent Diagnosis and Management

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