title: A national study to evaluate trends in the utilization of nerve reconstruction for treatment of neonatal brachial plexus palsy [outcomes article].
abstract: BACKGROUND
  Approximately 4 to 34 percent of infants born with neonatal brachial plexus palsy do not recover spontaneously and require surgery. Despite the increasing availability of microsurgical nerve repair, the authors hypothesize that this condition remains undertreated and that uninsured children and children with public insurance are less likely to receive treatment than those with private insurance.
  
  
  METHODS
  The authors used a national sample of inpatient hospital discharge data from the Healthcare Cost and Utilization Kids Inpatient Databases for the years 1997, 2000, 2003, and 2006. Relevant discharges were identified using the International Classification of Diseases, Ninth Revision diagnosis code 767.6 for neonatal brachial plexus palsy and procedure codes relating to nerve surgery. Weighted frequencies were calculated to generate national estimates for neonatal brachial plexus palsy births and nerve surgery procedures for these patients.
  
  
  RESULTS
  A total of 21,758 births with neonatal brachial plexus palsy and 721 admissions for nerve surgery were identified. Over time, utilization of nerve surgery procedures has generally increased (1.1 percent in 1997 to 3.2 percent in 2006). Treatment with nerve surgery varied significantly according to insurance status-3.8 percent among private insurance discharges, 2.9 percent among Medicaid insurance discharges, and 0.7 percent among self-pay/uninsured records (p < 0.001). The mean age among nerve surgery patients was 235 ± 75 days, and the mean total charges associated with microsurgical intervention was $24,534 ± $30,460.
  
  
  CONCLUSIONS
  Over the past decade, approximately 3.3 percent of neonatal brachial plexus palsy births have undergone some form of primary microsurgical nerve surgical intervention, which may reflect underutilization of these procedures and limited access to care. Insurance status plays a significant role in the use of nerve surgery procedures, as neonates without private insurance were less likely to receive nerve surgery procedures than those with private insurance.
authors.affiliation: Ann Arbor, Mich. From the University of Michigan Medical School and the Department of Neurosurgery, the Center for Statistical Consultation and Research, and the Section of Plastic Surgery, Department of Surgery, University of Michigan.
authors.forename: Lee
authors.initials: L
authors.lastname: Squitieri
authors.forename: Justin
authors.initials: J
authors.lastname: Steggerda
authors.forename: Lynda J-S
authors.initials: LJ
authors.lastname: Yang
authors.forename: H Myra
authors.initials: HM
authors.lastname: Kim
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
mesh_terms: D001917:Brachial Plexus / Q000293:injuries* / Q000601:surgery; D015331:Cohort Studies; D003625:Data Collection; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017057:Medically Uninsured; D006278:Medicare; D008866:Microsurgery / Q000706:statistics & numerical data; D010246:Paralysis, Obstetric / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States