title: Peripartum and neonatal factors associated with the persistence of neonatal brachial plexus palsy at 1 year: a review of 382 cases.
abstract: OBJECTIVE Neonatal brachial plexus palsy (NBPP) occurs due to the stretching of the nerves of the brachial plexus before, during, or after delivery. NBPP can resolve spontaneously or become persistent. To determine if nerve surgery is indicated, predicting recovery is necessary but difficult. Historical attempts explored the association of recovery with only clinical and electrodiagnostic examinations. However, no data exist regarding the neonatal and peripartum factors associated with NBPP persistence. METHODS This retrospective cohort study involved all NBPP patients at the University of Michigan between 2005 and 2015. Peripartum and neonatal factors were assessed for their association with persistent NBPP at 1 year, as defined as the presence of musculoskeletal contractures or an active range of motion that deviated from normal by > 10° (shoulder, elbow, hand, and finger ranges of motion were recorded). Standard statistical methods were used. RESULTS Of 382 children with NBPP, 85% had persistent NBPP at 1 year. A wide range of neonatal and peripartum factors was explored. We found that cephalic presentation, induction or augmentation of labor, birth weight > 9 lbs, and the presence of Horner syndrome all significantly increased the odds of persistence at 1 year, while cesarean delivery and Narakas Grade I to II injury significantly reduced the odds of persistence. CONCLUSIONS Peripartum/neonatal factors were identified that significantly altered the odds of having persistent NBPP at 1 year. Combining these peripartum/neonatal factors with previously published clinical examination findings associated with persistence should allow the development of a prediction algorithm. The implementation of this algorithm may allow the earlier recognition of those cases likely to persist and thus enable earlier intervention, which may improve surgical outcomes.
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wilson
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and.
authors.forename: Kate W C
authors.initials: KW
authors.lastname: Chang
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center, Houston, Texas.
authors.forename: Suneet P
authors.initials: SP
authors.lastname: Chauhan
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and.
authors.forename: Lynda J S
authors.initials: LJ
authors.lastname: Yang
mesh_terms: D001720:Birth Injuries / Q000150:complications* / Q000503:physiopathology; D001724:Birth Weight; D001917:Brachial Plexus / Q000293:injuries* / Q000503:physiopathology; D020516:Brachial Plexus Neuropathies / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D002585:Cesarean Section; D003286:Contracture; D005260:Female; D006732:Horner Syndrome / Q000150:complications; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007746:Labor Presentation; D007751:Labor, Induced / Q000009:adverse effects; D008297:Male; D016017:Odds Ratio; D011247:Pregnancy; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012307:Risk Factors
keywords: ACOG = American College of Obstetricians and Gynecologists; IRB = institutional review board; NBPP = neonatal brachial plexus palsy; UM-IBPP = University of Michigan Interdisciplinary Brachial Plexus Program; neonatal brachial plexus palsy; neonatal risk factors; peripartum risk factors; peripheral nerve