title: A multistate population-based analysis of linked maternal and neonatal discharge records to identify risk factors for neonatal brachial plexus injury.
abstract: OBJECTIVE
  To evaluate the interaction and contribution of maternal and fetal risk factors associated with neonatal brachial plexus injury (BPI).
  
  
  METHODS
  In a case-control study, matched maternal and neonatal discharge records were accessed from US State Inpatient Databases for New Jersey (2010-2012), Michigan (2010-2011), and Hawaii (2010-2011). Univariate and multivariate logistic regressions were used to evaluate associations between risk factors and BPI. Area under the receiver operating characteristic curve was used to build predictive models, including two stratified models evaluating deliveries among obese and diabetic cohorts.
  
  
  RESULTS
  Among 376 325 deliveries, BPI was diagnosed in 274 (0.1%). Significant BPI risk factors included maternal obesity (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.7-4.4), maternal diabetes (OR 4.6, 95% CI 3.0-7.0), use of forceps (OR 4.6, 95% CI 2.3-9.0), and vacuum assistance (OR 2.3, 95% CI 1.7-3.3). After adjusting for shoulder dystocia and other predictive factors, cesarean reduced the risk of BPI by 88% (OR 0.1, 95% CI 0.07-0.2). When stratified by obesity and diabetes, the ORs for BPI increased significantly for macrosomia, forceps, and vacuum assistance.
  
  
  CONCLUSIONS
  The analysis confirms and quantifies more precisely the impact of risk factors for neonatal BPI, and provides a reliable basis for evidence-based clinical decision-making models.
authors.affiliation: Oregon Health and Science University School of Medicine, Portland, OR, USA.|CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.|Forensic Research and Analysis, Portland, OR, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Freeman
authors.affiliation: Forensic Research and Analysis, Portland, OR, USA.
authors.forename: Shaun M
authors.initials: SM
authors.lastname: Goodyear
authors.affiliation: Forensic Research and Analysis, Portland, OR, USA.
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Leith
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000453:epidemiology* / Q000209:etiology; D001917:Brachial Plexus / Q000293:injuries*; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data*; D016208:Databases, Factual; D016640:Diabetes, Gestational / Q000453:epidemiology; D004420:Dystocia / Q000453:epidemiology; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology*; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D009772:Obstetrical Forceps / Q000009:adverse effects / Q000706:statistics & numerical data*; D011247:Pregnancy; D012372:ROC Curve; D012307:Risk Factors; D012782:Shoulder; D014481:United States; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects / Q000706:statistics & numerical data*
keywords: Cesarean delivery; Maternal diabetes; Maternal obesity; Neonatal brachial plexus injury; Shoulder dystocia, State Inpatient Databases