American Society for Peripheral Nerve
ASPN Home ASPN Home Past & Future Meetings Past & Future Meetings

Back to 2023 Abstracts


An Assessment of Risk Factors for Neonatal Brachial Plexus Palsy in the United States
Dhruv Mendiratta, BS1; Ashok Para, MD1; Aleksandra McGrath, MD, PHD2; Alice Chu, MD3
1Rutgers New Jersey Medical School, Newark, NJ; 2Chang Gung Memorial Hospital, Kweishan, Taiwan; 3Rutgers-New Jersey Medical School, Newark, NJ

Introduction: Neonatal brachial plexus palsy (NBPP) occurs during childbirth when excessive force is applied to brachial plexus structures. This study aims to identify risk factors that contribute to developing NBPP.
Materials & Methods: Neonates were identified using the United States 2016 Kids’ Inpatient Database (KID) (ICD-10: Z38). Patient and hospital demographics, maternal and infant comorbidities, and delivery methods were identified. Brachial plexus injuries were identified (ICD-10: P14.0 – 14.3). Univariate analyses were performed on patient and hospital demographics. Multivariate analyses were performed to determine significant risk factors for NBPP.
Results: 1,325,476 neonates were identified. 623,272 (47.0%) were female. 2,557 neonates (0.2%) were diagnosed with NBPP. All patient demographics, hospital region and hospital control varied with respect to plexus injury status. Teaching status of the hospital did not vary (Table 1). Females were 1.22 [CI: 1.12–1.32] times more likely to develop NBPP (p<0.001). Black and Native American neonates were 1.31 [CI: 1.12–1.55] and 1.60 [CI: 1.23–2.07] times more likely to develop NBPP, respectively (p<0.01). Patients birthed in a government-controlled hospital were 1.34 [CI: 1.15–1.56] times more likely to develop NBPP (p<0.01). Exceptionally large infants (>4500g) or post-term infants were 5.26 [CI: 4.83–5.75] times more likely to develop NBPP (p<0.001). Neonates with clavicle injuries at birth were 17.24 [CI: 14.71–20.41] times more likely to develop NBPP (p<0.001). Underweight infants (<2500g) were 4.27 [CI: 3.57–5.10] times less likely to develop an NBPP (p<0.001). Malpresentation during childbirth, including persistent occiput posterior, transverse lie, or shoulder dystocia was 76.92 [CI: 71.43–83.33] times more likely to develop NBPP (p=0.012, Table 2). NBPP patients were more likely to have undergone an instrument delivery (Table 1).
Conclusions: In this national cohort, NBPP occurred at an incidence of 1.93 per 1000 live births. Being female, Black, Native American, from a low-income household, born in a government-controlled hospital were all demographic predictors of NBPP. Pre-existing/gestational maternal diabetes, high gestational weight, clavicle fracture, and fetal malpresentation were all significant risk factors for NBPP. Preventative strategies targeted at these risk factors can be developed to improve perinatal outcomes.


Back to 2023 Abstracts