Incidence and Comorbidities Associated with Neonatal Brachial Plexus Palsy in the United States - Are We Improving
Nina Lightdale-Miric, MD; Paul Daniel Navo, MPH; Ram K. Alluri, MD; Gabriel Bouz, BA; Milan Stevanovic, MD, PhD; Alidad Ghiassi, MD
University of Southern California, Los Angeles, CA
Hypothesis: The purpose of this study was to determine the national incidence of congenital brachial plexus palsy (CBPP) and assess whether previously described risk factors have become less associated with CBPP by comparing 1997-2003 and 2006-2012. We hypothesized that with improvements in perinatal awareness and obstetric delivery prevention, known risk factors for CBPP would be less predictive in the later time cohort.
Methods: Datasets from the 1997 - 2012 Kids' Inpatient Database (KID) were utilized for this study. Patients with CBPP were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes. We excluded patients who underwent cesarean section. Potential risk factors for CBPP were also identified using ICD-9 codes. Risk factors that were predictive of developing CBPP on univariate analysis were analyzed in a multivariate logistic regression model for years 1997-2012. A subanalysis was performed comparing the odds ratios (OR) of developing CBPP for a particular risk factor in 1997-2003 (Group 1) versus 2006-2012 (Group 2) by creating an interaction term to assess if the risk factor was more or less predictive of developing CBPP based on temporal group.
Results: The nationwide incidence of CBPP was 0.14%, or approximately 1.38 cases per 1,000 live births, from 1997-2012 and progressively decreased by 0.01% every 3 years (P=0.03). In multivariate analysis, shoulder dystocia, large gestational weight (>4.5kg), and gestational diabetes had the highest odds ratio of developing CBPP (Table I). Multiple birth mates during delivery had a protective effect.
In comparing risk factors between 1997-2003 and 2006-2012, diabetic newborns were 73% less likely to have CBPP in the later time period (P=0.01) (Table II). Similarly, the OR for large baby, heavy for dates (large for dates regardless of gestation period), and shoulder dystocia decreased 22%, 14%, and 13%, respectively in the later time period (P<0.0001). The OR for gestational diabetes, vacuum extraction, forceps delivery, and breech delivery did not change between the two time periods (P>0.10). Multiple birth mates had a 49% greater protective effect on developing CBPP in the later time period (P=0.001).
- The national incidence of CBPP is decreasing, even after exclusion of cesarean section deliveries. This is likely due to improved awareness during perinatal care and prevention efforts during obstetric delivery.
- With respect to developing CBPP, management of neonatal diabetes, shoulder dystocia and large babies improved over time. However, management of gestational diabetes, breech delivery, and assisted vaginal delivery (forceps, vacuum) did not demonstrate similar improvement.
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