Prompt Referral in the Nonoperative Treatment of Obstetrical Brachial Plexus Injuries

Abstract

Background:Prompt physical and occupational therapy is crucial in managing nonsurgical candidates with obstetrical brachial plexus injuries (OBPI). The objective of our study was to identify newborns suffering from nonoperative OBPI in need of a “fast-track” evaluation by a multidisciplinary team.Methods:This is a retrospective review of patients with OBPI from June 1995 to June 2015. All nonsurgical candidates (Narakas class 1) were included in the study. The Gilbert score and the Medical Research Council grading system were used to measure shoulder and elbow function, respectively. The relationship between shoulder and elbow functional outcomes and time delay to consultation was studied using analysis of variance and Welch’s tests. Various subgroups were studied based on OBPI risk factors: maternal diabetes, birth weight >4 kg, use of forceps, asphyxia, multiple comorbidities, and Apgar score at 1 and 5 minutes.Results:A total of 168 patients were included in this study. Mean follow-up time was 313.8 weeks (minimum: 52; maximum: 1072; SD: 228.1). A total of 19 patients had an Apgar scores <7 at 5 minutes. Time delay between birth and the first consult to our clinic had an impact on shoulder outcome in the subgroup of newborns with Apgar scores <7 at 5 minutes.Conclusions:The subgroup of newborns with an Apgar score <7 at 5 minutes shows improved long-term shoulder function when promptly examined by an OBPI clinic. We recommend a “fast-track” referral for this time-sensitive population.

Obstetric Brachial Plexus Palsy of Newborns and Infants: Functional Outcomes after Rehabilitation by Their Own Parents

“…This incidence is largely dependent on the quality of pregnancy monitoring and obstetric care. The improvement of which over the past decade has been reported by several authors [11] The girl predominance in our series (52.3%) is reported by some authors [5] [6] [16] but the opposite observation is made by others [1] [2] [17]. This disparity could reflect a study population representative of the general population or the complete lack of a link between gender and OPBP.…”

Doğumsal Brakiyal Pleksus Felçli Bebeklerde Aile Odaklı Erken Terapi Programının Rolü

“…They stated that the early referral to the PMR clinic crucially prevents joint contractures. However, the frequency and intensity of physical therapy were not taken into account in this study (19) .…”