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The Orthopedic Clinics of North America Apr 2022Brachial plexus birth injuries (BPBIs) are typically traction type injuries to the newborn that occur during the delivery process. Although the incidence of these... (Review)
Review
Brachial plexus birth injuries (BPBIs) are typically traction type injuries to the newborn that occur during the delivery process. Although the incidence of these injuries has overall decreased from 1.5 to around 0.9 per 1000 live births in the United States over the past 2 decades, these injuries remain common, with incidence holding fairly steady from 2008 to 2014. Shoulder dystocia is the strongest identified risk factor, imparting a 100-fold greater risk. The newborn's shoulder is caught behind the mother's pubic bone, and traction performed on the child during delivery results in injury to the brachial plexus. Other risk factors associated with BPBI include macrosomia (birthweight > 4.5 kg), heavy for gestational age infants, birth hypoxia, gestational diabetes, and forceps or vacuum-assisted delivery. Breech presentation has also been described as a risk factor in the past, but there have been more recent data that challenge this association.
Topics: Birth Injuries; Birth Weight; Brachial Plexus; Child; Diabetes, Gestational; Dystocia; Female; Humans; Infant, Newborn; Pregnancy; United States
PubMed: 35365261
DOI: 10.1016/j.ocl.2021.11.003 -
Plastic and Reconstructive Surgery May 2023After studying this article, the participant should be able to: 1. Describe methods of clinical evaluation for neurologic recovery in brachial plexus birth injury. 2.... (Review)
Review
LEARNING OBJECTIVES
After studying this article, the participant should be able to: 1. Describe methods of clinical evaluation for neurologic recovery in brachial plexus birth injury. 2. Understand the role of different diagnostic imaging modalities to evaluate the upper limb. 3. List nonsurgical strategies and surgical procedures to manage shoulder abnormality. 4. Explain the advantages and disadvantages of microsurgical nerve reconstruction and distal nerve transfers in brachial plexus birth injury. 5. Recognize the prevalence of pain in this population and the need for greater sensory outcomes evaluation.
SUMMARY
Brachial plexus birth injury (BPBI) results from closed traction injury to the brachial plexus in the neck during an infant's vertex passage through the birth canal. Although spontaneous upper limb recovery occurs in most instances of BPBI, some infants do not demonstrate adequate motor recovery within an acceptable timeline and require surgical intervention to restore upper limb function. This article reviews major advances in the management of BPBI in the past decade that include improved understanding of shoulder pathology and its impact on observed motor recovery, novel surgical techniques, new insights in sensory function and pain, and global efforts to develop standardized outcomes assessment scales.
Topics: Infant; Humans; Brachial Plexus Neuropathies; Birth Injuries; Brachial Plexus; Neurosurgical Procedures; Nerve Transfer
PubMed: 37185378
DOI: 10.1097/PRS.0000000000010047 -
Archives of Gynecology and Obstetrics Oct 2023Previous studies have examined the optimal mode of breech delivery extensively, but there is a scarcity of publications focusing on the birth injuries of neonates born...
PURPOSE
Previous studies have examined the optimal mode of breech delivery extensively, but there is a scarcity of publications focusing on the birth injuries of neonates born in breech presentation. This study aimed to examine birth injury in breech deliveries.
METHODS
In this retrospective register-based nationwide cohort study, data on birth injuries in vaginal breech deliveries with singleton live births were compared to cesarean section with breech presentation and cephalic vaginal delivery between 2004 and 2017 in Finland. The data were retrieved from the National Medical Birth Register. Primary outcome variables were severe and mild birth injury. Incidences of birth injuries in different gestational ages and birthweights were calculated in different modes of delivery. Crude odds ratios of risk factors for severe birth injury were analyzed.
RESULTS
In vaginal breech delivery (n = 4344), there were 0.8% of neonates with severe birth injury and 1.5% of neonates with mild birth injury compared to 0.06% and 0.2% in breech cesarean section (n = 16,979) and 0.3% and 1.9% in cephalic vaginal delivery (n = 629,182). Brachial plexus palsy was the most common type of injury in vaginal breech delivery. Increasing gestational age and birthweight had a stronger effect on the risk for injury among cephalic vaginal deliveries than among vaginal breech deliveries.
CONCLUSION
Birth injuries were rare in vaginal breech deliveries. The incidence of severe birth injury was two times higher in vaginal breech delivery compared to cephalic vaginal delivery. Brachial plexus palsy was the most common type of injury in vaginal breech delivery.
Topics: Humans; Male; Female; Pregnancy; Infant, Newborn; Adult; Birth Injuries; Breech Presentation; Cesarean Section; Birth Weight; Delivery, Obstetric; Finland; Retrospective Studies; Cohort Studies; Paralysis
PubMed: 36074174
DOI: 10.1007/s00404-022-06772-1 -
Pediatric Neurology Nov 2022Publications regarding the epidemiology and management of brachial plexus birth injury (BPBI) were evaluated to investigate treatment guidelines for children with BPBI. (Review)
Review
BACKGROUND
Publications regarding the epidemiology and management of brachial plexus birth injury (BPBI) were evaluated to investigate treatment guidelines for children with BPBI.
METHODS
A search of neurology literature from 1990 to 2019 was performed using PubMed, Scopus, and Medline. Data including incidence, risk factors, spontaneous recovery rates, imaging studies, treatment recommendations, and indications and timing for surgery were collected.
RESULTS
A total of 46 total studies were reviewed. Reported incidence rates for BPBI ranged from 0.3 to 3 per 1000 births. Spontaneous recovery rates had an average reported range from 66% to 75%. Physical and occupational therapy were recommended in 37% of articles. Computed tomographic myelogram and magnetic resonance imaging of the brachial plexus were the most commonly recommended imaging studies for BPBI. Timelines for surgical interventions ranged from age three to nine months. Early referral was recommended in 28% of the articles included in the review.
CONCLUSIONS
Given the inconsistencies in spontaneous recovery rates, imaging recommendations, and timing of referral, establishing consistent clinical guidelines for patients with BPBI is crucial for management. Early referral to specialists for evaluation and treatment may improve outcomes in children with BPBI.
Topics: Birth Injuries; Brachial Plexus; Brachial Plexus Neuropathies; Child; Humans; Incidence; Infant; Neurology
PubMed: 36084421
DOI: 10.1016/j.pediatrneurol.2022.07.009 -
Seminars in Fetal & Neonatal Medicine Oct 2014Medical malpractice litigation in the USA and much of the developed world has reached near-epidemic proportions. Brain-damaged infants are among the most costly medical... (Review)
Review
Medical malpractice litigation in the USA and much of the developed world has reached near-epidemic proportions. Brain-damaged infants are among the most costly medical malpractice lawsuits, with the average indemnity for these cases being $524,047. Hypoxic-ischemic encephalopathy (HIE) is the most common birth injury claim, generally alleging that intrapartum asphyxia led to long-term neurologic sequelae, including cerebral palsy and/or developmental delay. Timing of injury is a key element in the legal arena. The plaintiff will try to prove that injury occurred in the intrapartum period, whereas the defense may argue that it occurred prenatally. A recent American Academy of Pediatrics/American College of Obstetricians and Gynecologists Task Force on Neonatal Encephalopathy developed a checklist that needs to be fulfilled in order to establish a reasonable causal link between an intrapartum asphyxial insult and subsequent long-term neurologic disability. Therapeutic hypothermia has been shown to benefit certain infants born with moderate to severe HIE by improving neurologic outcomes. Since the advent of hypothermic neuroprotection, new malpractice allegations have arisen, including the failure to refer a baby for cooling and failure to initiate cooling in a timely manner. In all cases, documentation of the status of the baby at birth, including a thorough neurologic exam, can be extremely helpful to the later defense of a malpractice claim, which might occur years later.
Topics: Birth Injuries; Humans; Hypoxia-Ischemia, Brain; Infant, Newborn; Malpractice
PubMed: 25150792
DOI: 10.1016/j.siny.2014.08.005 -
The Journal of Hand Surgery Feb 2018Brachial plexus birth injuries are rare, with treatment and follow-up often required from infancy until skeletal maturity. We review complications that may occur related... (Review)
Review
Brachial plexus birth injuries are rare, with treatment and follow-up often required from infancy until skeletal maturity. We review complications that may occur related to primary nerve surgery or secondary musculoskeletal procedures, and discuss how these may be avoided.
Topics: Birth Injuries; Brachial Plexus; Contracture; Diagnostic Errors; Humans; Intraoperative Care; Physical Examination; Postoperative Care; Postoperative Complications; Preoperative Care; Range of Motion, Articular; Upper Extremity
PubMed: 29421066
DOI: 10.1016/j.jhsa.2017.11.008 -
International Journal of Gynaecology... Oct 2022To examine severe birth-related injuries in neonates among mothers with different types of diabetes.
OBJECTIVE
To examine severe birth-related injuries in neonates among mothers with different types of diabetes.
METHODS
Retrospective cohort study based on Finnish Medical Birth Register data from 2004 to 2017. The study included singleton neonates born vaginally with cephalic presentation (n = 623 649) after 35 weeks of gestation. The primary outcome variable was severe birth injury. Incidences, crude and adjusted odds ratios, and probabilities in regression analysis were calculated for different types of diabetes.
RESULTS
There were 1952/623 649 (0.3%) severe birth injuries of which brachial plexus injury occurred most frequently. The injury incidence was highest in neonates of women with type 1 or type 2 diabetes, 42/1659 (2.5%) and 10/548 (1.8%), respectively. For gestational diabetes, the injury incidence was comparable to non-diabetic women: 422/77 810 (0.5%) and 1478/543 632 (0.3%), respectively. Shoulder dystocia, high birthweight, and vacuum-assisted delivery were associated with the highest probability for injury. Birthweight and obesity had a stronger impact on injury risk in women with pregestational diabetes compared to other pregnancies.
CONCLUSION
Neonates of women with pregestational diabetes have a higher risk for severe birth injury than other neonates. The injury risk in neonates delivered by women with gestational diabetes or non-diabetic women is generally low.
Topics: Birth Injuries; Birth Weight; Diabetes Mellitus, Type 2; Diabetes, Gestational; Dystocia; Female; Finland; Humans; Infant, Newborn; Pregnancy; Retrospective Studies; Risk Factors
PubMed: 34927725
DOI: 10.1002/ijgo.14073 -
The Journal of Neuroscience Nursing :... Dec 1991Brachial plexus birth injuries occur at a frequency of 1-2 per 1000 births. Many of these injuries spontaneously resolve. Should spontaneous recovery not occur within... (Review)
Review
Brachial plexus birth injuries occur at a frequency of 1-2 per 1000 births. Many of these injuries spontaneously resolve. Should spontaneous recovery not occur within the first 4-6 months of life, the prognosis for attaining movement and function of the affected appendage is significantly impaired. The child demonstrates a lifelong disfiguring and functional handicap. With advances in technology, diagnosis and microsurgical techniques, surgical exploration of the brachial plexus has been revived. A multidisciplinary approach has provided dynamic results. At present only one institution in the United States utilizes this innovative protocol. This article addresses the collaborative perioperative nursing implications for a child with brachial plexus birth injury.
Topics: Birth Injuries; Brachial Plexus; Combined Modality Therapy; Humans; Infant; Infant, Newborn; Neurologic Examination; Nursing Assessment; Patient Care Team; Postoperative Complications
PubMed: 1839546
DOI: 10.1097/01376517-199112000-00006 -
Clinical Obstetrics and Gynecology Sep 2007A practical clinical review of those aspects of shoulder dystocia management that are directly relevant to birth injury is presented. In contrast to more popular... (Review)
Review
A practical clinical review of those aspects of shoulder dystocia management that are directly relevant to birth injury is presented. In contrast to more popular viewpoints, the tenets of this paper are that, with few exceptions, clinically relevant, permanent brachial plexus injury is nearly universally associated with shoulder dystocia, injury is causally related to mechanical stresses induced during shoulder dystocia delivery, and management algorithms can be optimized to reduce the incidence of mechanical birth injury from shoulder dystocia. Advantages of direct rotational manipulation of the fetus within the birth canal are emphasized, supported by critical analysis of maneuver-related outcomes research. The competing issue of potential asphyxial insult with prolonged shoulder dystocia is addressed in light of evidence for differential time-dependency between central and peripheral nerve injury as head-to-body interval increases. The importance of proper execution of shoulder dystocia maneuvers for maximizing favorable outcome of shoulder dystocia is iterated, as is coordination of teamed response by multiple healthcare providers. To avoid permanent neurologic sequelae from shoulder dystocia, clinicians are encouraged to be ever mindful of traction applied to the fetal head and neck, to become adept at performance of alternative maneuvers that instead concentrate on finesse rather than force, and to be more favorably disposed to the use of such maneuvers early and often in shoulder dystocia management algorithms.
Topics: Birth Injuries; Brachial Plexus Neuropathies; Delivery, Obstetric; Dystocia; Female; Humans; Infant, Newborn; Pregnancy; Risk Factors; Shoulder; Time Factors
PubMed: 17762412
DOI: 10.1097/GRF.0b013e31811eaba2 -
Pediatric Clinics of North America Dec 1993Although significant birth injury accounts for few neonatal deaths and stillborns in the United States, it still occasionally and unavoidably occurs. This article... (Review)
Review
Although significant birth injury accounts for few neonatal deaths and stillborns in the United States, it still occasionally and unavoidably occurs. This article reviews soft tissue, peripheral nerve, intrathoracic, and intra-abdominal injury.
Topics: Abdominal Injuries; Birth Injuries; Connective Tissue; Humans; Infant, Newborn; Peripheral Nerve Injuries
PubMed: 8255629
DOI: 10.1016/s0031-3955(16)38665-5