Persistence of Neonatal Brachial Plexus Palsy among Nulliparous Versus Parous Women

McLaren, Rodney; Chang, Kai-Ting; Ankumah, Nana-Ama; Yang, Lynda J.‐S.; Chauhan, Suneet P.

doi:10.1055/s-0038-1677051

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…Injury to the brachial plexus at birth (neonatal brachial plexus injury – NBPI) is the most common cause of upper limb paralysis in children ( Foad et al, 2008 ), occurring in approximately 1.5 of every 1000 live births, in both females and males at an equal rate ( McLaren et al, 2019 ). This initial nerve injury leads to permanent neurologic deficits in 20–40% of affected children ( Govindan and Burrows, 2019 ; Pondaag et al, 2004 ), and results in the secondary formation of disabling and incurable muscle contractures, or joint stiffness.…”

Section: Introductionmentioning

confidence: 99%

Sex-specific role of myostatin signaling in neonatal muscle growth, denervation atrophy, and neuromuscular contractures

Emmert

Aggarwal

Shay-Winkler

et al. 2022

eLife

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Neonatal brachial plexus injury (NBPI) causes disabling and incurable muscle contractures that result from impaired longitudinal growth of denervated muscles. This deficit in muscle growth is driven by increased proteasome-mediated protein degradation, suggesting a dysregulation of muscle proteostasis. The myostatin (MSTN) pathway, a prominent muscle-specific regulator of proteostasis, is a putative signaling mechanism by which neonatal denervation could impair longitudinal muscle growth, and thus a potential target to prevent NBPI-induced contractures. Through a mouse model of NBPI, our present study revealed that pharmacologic inhibition of MSTN signaling induces hypertrophy, restores longitudinal growth, and prevents contractures in denervated muscles of female but not male mice, despite inducing hypertrophy of normally innervated muscles in both sexes. Additionally, the MSTN-dependent impairment of longitudinal muscle growth after NBPI in female mice is associated with perturbation of 20S proteasome activity, but not through alterations in canonical MSTN signaling pathways. These findings reveal a sex dimorphism in the regulation of neonatal longitudinal muscle growth and contractures, thereby providing insights into contracture pathophysiology, identifying a potential muscle-specific therapeutic target for contracture prevention, and underscoring the importance of sex as a biological variable in the pathophysiology of neuromuscular disorders.

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Section: Introductionmentioning

confidence: 99%

Sex-specific role of myostatin signaling in neonatal muscle growth, denervation atrophy, and neuromuscular contractures

Emmert

Aggarwal

Shay-Winkler

et al. 2022

eLife

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“…Previous studies evaluating the relationship of parity and brachial plexus birth injury report conflicting results, 20–22,28,29,54,55 including a reported increased risk in primiparous patients, 26,28 in multiparous patients, 55 or no difference related to parity. 22 Contradicting results from prior studies are difficult to interpret.…”

Section: Discussionmentioning

confidence: 96%

Association of Parity and Previous Birth Outcome With Brachial Plexus Birth Injury Risk

Manske,

Wilson,

Wise

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To evaluate the association of maternal delivery history with a brachial plexus birth injury risk in subsequent deliveries and to estimate the effect of subsequent delivery method on brachial plexus birth injury risk. METHODS: We conducted a retrospective cohort study of all live-birth deliveries occurring in California-licensed hospitals from 1996 to 2012. The primary outcome was recurrent brachial plexus birth injury in a subsequent pregnancy. The exposure was delivery history (parity, shoulder dystocia in a previous delivery, or previously delivering a neonate with brachial plexus birth injury). Multiple logistic regression was used to model adjusted associations of delivery history with brachial plexus birth injury in a subsequent pregnancy. The adjusted risk and adjusted risk difference for brachial plexus birth injury between vaginal and cesarean deliveries in subsequent pregnancies were determined, stratified by delivery history, and the number of cesarean deliveries needed to prevent one brachial plexus birth injury was determined. RESULTS: Of 6,286,324 neonates delivered by 4,104,825 individuals, 7,762 (0.12%) were diagnosed with a brachial plexus birth injury. Higher parity was associated with a 5.7% decrease in brachial plexus birth injury risk with each subsequent delivery (adjusted odds ratio [aOR] 0.94, 95% CI 0.92–0.97). Shoulder dystocia or brachial plexus birth injury in a previous delivery was associated with fivefold (0.58% vs 0.11%, aOR 5.39, 95% CI 4.10–7.08) and 17-fold (1.58% vs 0.11%, aOR 17.22, 95% CI 13.31–22.27) increases in brachial plexus birth injury risk, respectively. Among individuals with a history of delivering a neonate with a brachial plexus birth injury, cesarean delivery was associated with a 73.0% decrease in brachial plexus birth injury risk (0.60% vs 2.21%, aOR 0.27, 95% CI 0.13–0.55) compared with an 87.9% decrease in brachial plexus birth injury risk (0.02% vs 0.15%, aOR 0.12, 95% CI 0.10–0.15) in individuals without this history. Among individuals with a history of brachial plexus birth injury, 48.1 cesarean deliveries are needed to prevent one brachial plexus birth injury. CONCLUSIONS: Parity, previous shoulder dystocia, and previously delivering a neonate with brachial plexus birth injury are associated with future brachial plexus birth injury risk. These factors are identifiable prenatally and can inform discussions with pregnant individuals regarding brachial plexus birth injury risk and planned mode of delivery.

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“…Our findings differ from other publications on the topic in three important ways. First, prior publications on children with NBPP often relied on parents' recall of obstetric events, 14,16,25 which may be biased. Second, prior reports linking shoulder dystocia with NBPP did not have children evaluated in a consistent manner.…”

Section: Discussionmentioning

confidence: 99%

Persistence and Extent of Neonatal Brachial Plexus Palsy: Association with Number of Maneuvers and Duration of Shoulder Dystocia

Doty

Chauhan

Chang

et al. 2020

AJP Rep

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Objective The main objective of this article is to determine if persistence of neonatal brachial plexus palsy (NBPP) following shoulder dystocia was associated with maneuvers used or duration of impacted shoulder. Study Design Retrospective review of children with NBPP and documented shoulder dystocia. Student t-tests and chi-squared tests were used to compare outcomes when shoulder dystocia resolved with > 3 versus ≤ 3 maneuvers or duration > versus ≤ 120 seconds. Relative risk (RR) with 95% confidence intervals (CI) was calculated. Results Among 46 children with NBPP and shoulder dystocia, incidence of persistence was significantly higher at 2 years of age when > 3 versus ≤ 3 maneuvers were used (100 vs. 62%; RR: 1.6, 95% CI: 1.2–2.2). When resolution of impacted shoulder lasted >120 versus ≤ 120 seconds, NBPP at 2 years was significantly more likely (100 vs. 63%; RR: 1.6, 95% CI: 1.1–2.2). Injury to all five nerves of the brachial plexus was more likely if standard deviation lasted > 120 versus ≤ 120 seconds (RR: 2.2; 95% CI: 1.03–4.6). Conclusion Though the number of maneuvers used and duration of shoulder dystocia are associated with persistence of NBPP, the retrospective nature of the study of a selective cohort precludes recommendations changing the current management of shoulder dystocia.

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Persistence of Neonatal Brachial Plexus Palsy among Nulliparous Versus Parous Women

Cited by 4 publications

References 10 publications

Sex-specific role of myostatin signaling in neonatal muscle growth, denervation atrophy, and neuromuscular contractures

Sex-specific role of myostatin signaling in neonatal muscle growth, denervation atrophy, and neuromuscular contractures

Association of Parity and Previous Birth Outcome With Brachial Plexus Birth Injury Risk

Persistence and Extent of Neonatal Brachial Plexus Palsy: Association with Number of Maneuvers and Duration of Shoulder Dystocia

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