Risk Factors for Brachial Plexus Birth Injury

Louden, Emily; Marcotte, Michael; Mehlman, Charles T.; Lippert, William C.; Huang, Bin; Paulson, Andrea

doi:10.3390/children5040046

Cited by 18 publications

(15 citation statements)

References 32 publications

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“…The characteristics of the 22 included articles are listed in Table S2 (online supporting information). Twelve were cohort studies and 10 were case–control studies . Only four studies had a prospective design .…”

Section: Resultsmentioning

confidence: 99%

“…Only four studies had a prospective design . Nine studies were conducted in Europe, seven in North America, five in Asia, and one in Australia . The primary outcome in each study was risk factors for NBPP.…”

Section: Resultsmentioning

confidence: 99%

“…(Gestational) diabetes as a risk factor with an odds ratio of 5.33 (95% CI 3.77–7.55; I 2 =59%; n =1 651 281) was explored in 10 studies (Fig. S3c).…”

Section: Resultsmentioning

confidence: 99%

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

Looven

Roy

Tanghe

et al. 2019

Develop Med Child Neuro

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Aim To provide a comprehensive update on the most prevalent, significant risk factors for neonatal brachial plexus palsy (NBPP). Method Cochrane CENTRAL, MEDLINE, Web of Science, Embase, and ClinicalTrials.gov were searched for relevant publications up to March 2019. Studies assessing risk factors of NBPP in relation to typically developing comparison individuals were included. Meta‐analysis was performed for the five most significant risk factors, on the basis of the PRISMA statement and MOOSE guidelines. Pooled odds ratios (ORs), 95% confidence intervals (CIs), and across‐study heterogeneity (I2) were reported. Reporting bias and quality of evidence was rated. In addition, we assessed the incidence of NBPP. Results Twenty‐two observational studies with a total sample size of 29 419 037 live births were selected. Significant risk factors included shoulder dystocia (OR 115.27; 95% CI 81.35–163.35; I2=92%), macrosomia (OR 9.75; 95% CI 8.29–11.46; I2=70%), (gestational) diabetes (OR 5.33; 95% CI 3.77–7.55; I2=59%), instrumental delivery (OR 3.8; 95% CI 2.77–5.23; I2=77%), and breech delivery (OR 2.49; 95% CI 1.67–3.7; I2=70%). Caesarean section appeared as a protective factor (OR 0.13; 95% CI 0.11–0.16; I2=41%). The pooled overall incidence of NBPP was 1.74 per 1000 live births. It has decreased in recent years. Interpretation The incidence of NBPP is decreasing. Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are risk factors for NBPP. Caesarean section appears as a protective factor. What this paper adds The overall incidence of neonatal brachial plexus palsy is 1.74 per 1000 live births. The incidence has declined significantly. Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are the main risk factors. Prevention is difficult owing to unpredictability and often labour‐related risk.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Looven

Roy

Tanghe

et al. 2019

Develop Med Child Neuro

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“…Longitudinal studies have assessed risk factors in infants for developing PNI during delivery, such as shoulder dystocia, large for gestational age, maternal diabetes, and use of forceps, breech, or vacuum delivery [ 13 , 14 ]. The aforementioned risk factors were found to be associated with a higher risk of PNI during the perinatal period, but they were only found to be predictive in 10–19% of cases.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Contralateral Diaphragm Paralysis following Birth Injury with Brachial Plexus Palsy: A Case Report and Review of the Literature

Reiter

Rizeq

Many

et al. 2020

Case Reports in Pediatrics

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Clinical History. A 4.4 kg male was born to a 25-year-old, G2P1, nondiabetic woman at 39 and 5/7 weeks. Delivery was complicated by shoulder dystocia requiring forceps-assisted vaginal delivery, resulting in left arm Erb’s palsy secondary to left brachial plexus injury. He was born with low muscle tone and bradycardia and subsequently required intubation for poor respiratory effort. He was extubated on day one of life but continued to be tachypneic and have borderline oxygen saturation, requiring intensive care. Chest radiographs demonstrated a progressive clearing of his lung fields, consistent with presumptively diagnosed meconium aspiration. However, a persistent elevation of the right hemidiaphragm was noted, and his tachypnea and increased work of breathing continued. Focused ultrasound of the diaphragm was performed, confirming decreased motion of the right hemidiaphragm. Following a multidisciplinary discussion, thoracoscopic right diaphragm plication was performed on the 33rd day of life. He was extubated postoperatively and subsequently weaned to room air with a notable decrease in tachypnea over 48 hours. He was discharged on postoperative day 12 and continues to thrive at 6 months of age without respiratory embarrassment. Purpose. Ipsilateral phrenic nerve injury with diaphragm paralysis from shoulder dystocia during vaginal delivery is a recognized phenomenon. Herein, we present a case of contralateral diaphragm paralysis in order to draw attention to the clinician that this discordance is possible. Key Points. According to Raimbault et al., clinical management of newborns who experience birth injury is a multidisciplinary effort. According to Fitting and Grassino, though most cases of phrenic nerve injuries are ipsilateral to shoulder dystocia brachial plexus palsy, contralateral occurrence is possible and should be considered. According to Waters, diaphragm plication is a safe and effective operation.

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“…Some studies have reported that breech presentation is the more important risk factor for simultaneous brachial plexus and phrenic nerve palsies. [1][2][3][4] Complete BPBI would manifest with a hypotonic upper arm. There is generally no active abduction of the arm with absent deep tendon reflexes and asymmetrical Moro's reflex in the affected arm.…”

Section: Introductionmentioning

confidence: 99%

Rare case of a newborn baby with left-sided Erb’s palsy and a contralateral/right-sided paralysis of the diaphragm

Pegu¹,

Deb

Kalapesi

2018

BMJ Case Reports

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Brachial plexus birth injury (BPBI) and phrenic nerve injury can sometimes occur concurrently in neonates following difficult deliveries like breech presentation, shoulder dystocia, forceps or vacuum extraction. Phrenic nerve palsy should be suspected in a newborn with respiratory distress and an elevated hemidiaphragm on the imaging studies in presence of the associated risk factors. The right side is affected more often than the left side and most of it is associated with BPBI. We present here a rare case of a newborn baby with a left-sided Erb’s palsy and a contralateral/right-sided diaphragmatic paralysis who recovered from the persistent respiratory distress and feeding difficulties following plication of the diaphragm. The left-sided Erb’s palsy also fully recovered at follow-up examination.

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Risk Factors for Brachial Plexus Birth Injury

Cited by 18 publications

References 32 publications

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

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

A Rare Case of Contralateral Diaphragm Paralysis following Birth Injury with Brachial Plexus Palsy: A Case Report and Review of the Literature

Rare case of a newborn baby with left-sided Erb’s palsy and a contralateral/right-sided paralysis of the diaphragm

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