title: Birth trauma--risk factors and short-term neonatal outcome.
abstract: OBJECTIVE
  The ability to predict birth trauma (BT) based on the currently recognized risk factors is limited and there is little information regarding the short-term neonatal outcome following BT. We aimed to identify risk factors for BT and to evaluate the effect of BT on short-term neonatal outcome.
  
  
  METHODS
  A retrospective, cohort, case-control study of all cases of BT in a single tertiary center (1986-2009). The control group included the two subsequent full-term singleton neonates who did not experienced BT. Short-term neonatal outcome was compared between the groups including Apgar scores, NICU admission, duration of hospitalization and neurologic, respiratory and metabolic morbidity.
  
  
  RESULTS
  Of the 118 280 singleton full-term newborns delivered during the study period, 2874 were diagnosed with BT (24.3/1000). The most frequent types of BT were scalp injuries (63.9%, 15.5/1000) and clavicular fracture (32.1%, 7.7/1000). The following factors were found to be independent risk factors for BT: instrumental delivery (OR 7.5, 95% CI 6.3-8.9), birth weight, delivery during risk hours, parity, maternal age and neonatal head circumference. Cesarean delivery was the only factor protective of BT (OR 0.2, 95% CI 0.2-0.3). Neonates in the study group had a prolonged length of hospital stay (3.3 versus 2.7 d, p = 0.001), were more likely to be admitted to the NICU (3.9% versus 1.9%, p < 0.001), and had a higher rate of jaundice (11.9% versus 7.1%, p < 0.001) and neurological morbidity (4.7% versus 2.3%, p < 0.001).
  
  
  CONCLUSIONS
  Instrumental delivery appears to be responsible for most cases of neonatal BT.
authors.affiliation: Department of Neonatology and.
authors.forename: Nechama
authors.initials: N
authors.lastname: Linder
authors.forename: Ido
authors.initials: I
authors.lastname: Linder
authors.forename: Elena
authors.initials: E
authors.lastname: Fridman
authors.forename: Frank
authors.initials: F
authors.lastname: Kouadio
authors.forename: Daniel
authors.initials: D
authors.lastname: Lubin
authors.forename: Paul
authors.initials: P
authors.lastname: Merlob
authors.forename: Yariv
authors.initials: Y
authors.lastname: Yogev
authors.forename: Nir
authors.initials: N
authors.lastname: Melamed
mesh_terms: D000328:Adult; D001034:Apgar Score; D001720:Birth Injuries / Q000150:complications* / Q000628:therapy*; D001724:Birth Weight; D016022:Case-Control Studies; D002968:Clavicle / Q000293:injuries; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000295:instrumentation / Q000379:methods; D005260:Female; D050723:Fractures, Bone; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D007902:Length of Stay; D008297:Male; D008423:Maternal Age; D010298:Parity; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D012535:Scalp / Q000293:injuries; D016896:Treatment Outcome