Risk Factors and Incidence of Global Developmental Delay and Autism Spectrum Disorder in Infants with Brachial Plexus Birth Injury
Thomas J. McQuillan, MD1, Daniel C. Gabriel, BS2, Peter M. Waters, MD3 and Andrea S Bauer, MD3, 1Boston Children's Hospital, BOSTON, MA, 2Harvard Medical School, Boston, MA, 3Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
Introduction
Global developmental delay (GDD) and autism spectrum disorder (ASD) are two common central nervous system (CNS) diagnoses that may be related to traumatic births. We hypothesized that the incidence of GDD and ASD would be increased in our cohort of brachial plexus birth injury (BPBI) patients, and that this subgroup of patients would have increased rates of maternal risk factors and birth-related complications.
Materials and Methods
We leveraged a large, single institution prospective cohort that continuously enrolled 849 patients seen with BPBI from the years 1999-2019. Demographic information, birth history, and maternal risk factors were recorded. Charts were individually reviewed including all pediatric/medical, orthopaedic, and therapy notes for diagnoses of GDD and ASD made before the age of 5 years using standard definitions. Cohorts were compared using chi-squared and Fisher’s exact tests regarding demographics, maternal and birth-related risk factors to assess for differences between groups.
Results
Five hundred and fifty-seven patients had sufficient follow-up to assess for diagnosis of GDD or ASD. Seventeen patients had a diagnosis of GDD (13) or ASD (4) before the age of 5 years, resulting in an incidence of 3.1%. Cohorts were similar in terms of sex, race, affected side and maternal characteristics including gestational diabetes, difficult delivery, or pre-eclampsia (Table 1). However, patients with GDD or ASD had a significantly increased likelihood of birth asphyxia in the child (62.5% vs 22.7% for all others, p <0.001) and history of NICU admission (62.5% vs 33.9%, p = 0.017). Rates of shoulder dystocia did not differ between the cohorts (Table 1).
Conclusions
The incidence of GDD/ASD is 3.1% in this cohort of patients with BPBI, which is higher than national projections and likely is still under-recognized in this retrospective study. Child-related birth complications, especially birth asphyxia and NICU admission, are significantly associated with GDD/ASD in patients with BPBI. Providers should consider additional neurologic screening for infants with BPBI who have a history of birth asphyxia and/or NICU admission.
Back to 2024 Abstracts