Etiological risk factors for brachial plexus palsy.
ABSTRACT To investigate risk factors for brachial plexus palsy in newborns. We analyzed 45 544 live-born children, born over a nine-year period from January 1, 1996 to December 31, 2004.
The analysis was retrospective and based on the medical documentation of the Clinic for Gynecology and Obstetrics, Clinic for Neurology, and Clinic for Physical Medicine and Rehabilitation of the University Clinical Center Tuzla. We compared study and control groups of newborns. Rates among groups were compared using Chi-square, with significance at p < 0.05, and with significance at p < 0.01.
Examining epidemiological characteristics, 86 newborns with brachial plexus palsy had been recorded, thus, the prevalence was 1.86 per 1000 live-born children. Analyzing maternal and neonatal factors, and the labor pattern itself, it was found that the highest factors of risk for brachial plexus injury were birth weight of over 4000 g, a precipitous second stage of labor (<15 minutes), and vacuum-extractor assisted labor. Brachial plexus palsy was more frequent when the mothers were overweight, with a body mass index >or=29 kg/m2. None of the parturient women, whose newborns were diagnosed with brachial plexus palsy, had external conjugate diameter <18 cm. Newborns delivered vaginally were not diagnosed with a higher frequency of brachial plexus palsy when compared to newborns who were delivered by cesarean section, but newborns who were vaginal breech-delivered were diagnosed to have a higher incidence of brachial plexus palsy. Newborns whose mothers were older than 35 years were diagnosed to have brachial plexus palsy more frequently, but a statistically significant difference between primiparas and multiparas was not found. A total of 39 newborns (45.2%) were diagnosed with a fracture of the clavicle, which was the most frequently combined damage with brachial plexus injury. Forty-two newborns (48.8%) had an Apgar score of <or=7 in the first minute after delivery, which indicates intrapartal fetal distress and is an indication of the traumatic nature of these deliveries. The average birth weight of newborns with brachial plexus damage was 3858.1+/-587.7 g, which for an average gestational age of 38.8+/-1.8 weeks, corresponds to eutrophic newborns. Both male and female newborns were diagnosed to have brachial plexus palsy comparably frequently, and almost all deliveries (97.7%) were initiated spontaneously. The majority of newborns were born between the hours of 02:00 and 03:00 and between the hours of 14:00-15:00.
Article: Obstetrical brachial plexus palsy.[Show abstract] [Hide abstract]
ABSTRACT: In this article, the authors review their approach to evaluation, operative management, and reconstructive technique. Brachial plexus injuries in the newborn are usually managed nonoperatively. The timing and indications for primary surgery vary significantly between institutions. The motor examination is used to determine which infants would benefit from operative management. Patients are selected based on established criteria, such as the Toronto Test Score, applied at age 3 months. However, some cases are initially less clear, and we may recommend delaying operative management until age 6 months or as late as age 9 months if the child fails the cookie test. Neuroma excision, sural nerve grafting, and nerve transfers are performed when indicated by clinical motor examination. The use of selective motor nerve transfers, either in combination with nerve grafting or alone, has allowed nerve coaptations to be performed closer to the neuromuscular junction, which may further improve regeneration. Children undergoing primary surgery experience low rates of perioperative morbidity, and they experience gains in motor function until 3 or 4 years postoperatively, at which point recovery stabilizes.Plastic and reconstructive surgery 07/2009; 124(1 Suppl):144e-155e. · 2.74 Impact Factor
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ABSTRACT: The objective of this chapter is to describe and discuss the radiographic, intraoperative, and histologic findings that are present after brachial plexus birth injury. This review is based on the authors’ clinical and operative experiences and a survey of the peer-reviewed literature. Together our findings provide evidence that in the vast majority of cases of brachial plexus birth palsy are secondary to a forceful traction injury affecting the brachial plexus that occurs when the child is born. KeywordsBirth palsy–brachial plexus–nerve injury–neuroma–shoulder dystocia12/2008: pages 289-294;
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ABSTRACT: Antecedentes: Se define trauma al nacimiento las lesiones sufridas por el feto durante el trabajo de parto o expulsión. Objetivo: Identificar los factores de riesgo asociados a lesiones originadas durante el nacimiento en recién nacidos. Método: Estudio casos y controles, realizado en el período de julio/2004 a diciembre/2005, en la División de Ginecología y Obstetricia del Hospital General de Caxias do Sul/ Facultad de Medicina, Universidad de Caxias do Sul, RS, Brasil. Fueron analizadas variables maternas, del parto y fetales, utilizando el programa estadístico SPSS versión 19.0. Los factores que obtuvieron nivel significativo <0,10 en los análisis bivariado fueron insertas en la regresión logística. Se utilizó el modelo de entrada por bloques (block entry) para selección del modelo final de la regresión. Resultados: En el período citado nacieron 2.137 infantes, 26 de ellos (1,2%) sufrieron trauma al nacimiento. La fractura de clavícula fue la lesión más frecuente (n=14; 53,8%), seguida del cefalohematoma (n=5; 19,2%). Las variables gasométricas no presentaron diferencia estadística. En la regresión logística, las únicas variables independientes asociadas a traumatismo al nacimiento fueron parto vaginal (OR-A: 11,08; IC95%: 2,45-49,98; p=0,002) y perímetro torácico >33 cm (OR-A: 3,36; IC95%: 1,35-9,73; p=0,010). Conclusión: Los factores de riesgo asociados a lesiones durante el nacimiento involucran el parto vaginal y el perímetro torácico igual o superior a 33cm.Revista Chilena de Obstetricia y Ginecologia 12/2011; 77(1):35-39.