Persistence and Extent of Neonatal Brachial Plexus Palsy: Association with Number of Maneuvers and Duration of Shoulder Dystocia

Abstract

Objective The main objective of this article is to determine if persistence of neonatal brachial plexus palsy (NBPP) following shoulder dystocia was associated with maneuvers used or duration of impacted shoulder.

Study Design Retrospective review of children with NBPP and documented shoulder dystocia. Student t-tests and chi-squared tests were used to compare outcomes when shoulder dystocia resolved with > 3 versus ≤ 3 maneuvers or duration > versus ≤ 120 seconds. Relative risk (RR) with 95% confidence intervals (CI) was calculated.

Results Among 46 children with NBPP and shoulder dystocia, incidence of persistence was significantly higher at 2 years of age when > 3 versus ≤ 3 maneuvers were used (100 vs. 62%; RR: 1.6, 95% CI: 1.2–2.2). When resolution of impacted shoulder lasted >120 versus ≤ 120 seconds, NBPP at 2 years was significantly more likely (100 vs. 63%; RR: 1.6, 95% CI: 1.1–2.2). Injury to all five nerves of the brachial plexus was more likely if standard deviation lasted > 120 versus ≤ 120 seconds (RR: 2.2; 95% CI: 1.03–4.6).

Conclusion Though the number of maneuvers used and duration of shoulder dystocia are associated with persistence of NBPP, the retrospective nature of the study of a selective cohort precludes recommendations changing the current management of shoulder dystocia.

Keywords

neonatal brachial plexus palsy - shoulder dystocia

• References

• 1 The American College of Obstetricians and Gynecologists Task Force on Neonatal Brachial Plexus Palsy. Neonatal Brachial Plexus Palsy. Washington, DC: 2014
• 2 Chauhan SP, Blackwell SB, Ananth CV. Neonatal brachial plexus palsy: incidence, prevalence, and temporal trends. Semin Perinatol 2014; 38 (04) 210-218
• 3 Kambhampati SB, Birch R, Cobiella C, Chen L. Posterior subluxation and dislocation of the shoulder in obstetric brachial plexus palsy. J Bone Joint Surg Br 2006; 88 (02) 213-219
• 4 Arad E, Stephens D, Curtis CG, Clarke HM. Botulinum toxin for the treatment of motor imbalance in obstetrical brachial plexus palsy. Plast Reconstr Surg 2013; 131 (06) 1307-1315
• 5 Moukoko D, Ezaki M, Wilkes D, Carter P. Posterior shoulder dislocation in infants with neonatal brachial plexus palsy. J Bone Joint Surg Am 2004; 86 (04) 787-793
• 6 Bauer AS, Lucas JF, Heyrani N, Anderson RL, Kalish LA, James MA. Ultrasound screening for posterior shoulder dislocation in infants with persistent brachial plexus birth palsy. J Bone Joint Surg Am 2017; 99 (09) 778-783
• 7 Tang M, Gorbutt KA, Peethambaran A, Yang L, Nelson VS, Chang KW. High prevalence of cranial asymmetry exists in infants with neonatal brachial plexus palsy. J Pediatr Rehabil Med 2016; 9 (04) 271-277
• 8 Brown SH, Wernimont CW, Phillips L, Kern KL, Nelson VS, Yang LJ. Hand sensorimotor function in older children with neonatal brachial plexus palsy. Pediatr Neurol 2016; 56: 42-47
• 9 Vekris MD, Lykissas MG, Beris AE, Manoudis G, Vekris AD, Soucacos PN. Management of obstetrical brachial plexus palsy with early plexus microreconstruction and late muscle transfers. Microsurgery 2008; 28 (04) 252-261
• 10 Alyanak B, Kılınçaslan A, Kutlu L, Bozkurt H, Aydın A. Psychological adjustment, maternal distress, and family functioning in children with obstetrical brachial plexus palsy. J Hand Surg Am 2013; 38 (01) 137-142
• 11 McCann ME, Waters P, Goumnerova LC, Berde C. Self-mutilation in young children following brachial plexus birth injury. Pain 2004; 110 (1-2): 123-129
• 12 Herbst MA. Treatment of suspected fetal macrosomia: a cost-effectiveness analysis. Am J Obstet Gynecol 2005; 193 (3 Pt 2): 1035-1039
• 13 Committee on Practice Bulletins—Obstetrics. Practice Bulletin No 178: shoulder dystocia. Obstet Gynecol 2017; 129 (05) e123-e133
• 14 Chang KW, Ankumah NA, Wilson TJ, Yang LJ, Chauhan SP. Persistence of neonatal brachial plexus palsy associated with maternally reported route of delivery: review of 387 cases. Am J Perinatol 2016; 33 (08) 765-769
• 15 Chauhan SP, Gherman R, Hendrix NW, Bingham JM, Hayes E. Shoulder dystocia: comparison of the ACOG practice bulletin with another national guideline. Am J Perinatol 2010; 27 (02) 129-136
• 16 Chauhan SP, Chang KW, Ankumah NE, Yang LJ. Neonatal brachial plexus palsy: obstetric factors associated with litigation. J Matern Fetal Neonatal Med 2017; 30 (20) 2428-2432
• 17 Chauhan SP, Laye MR, Lutgendorf M. , et al. A multicenter assessment of 1,177 cases of shoulder dystocia: lessons learned. Am J Perinatol 2014; 31 (05) 401-406
• 18 Ouzounian JG, Korst LM, Miller DA, Lee RH. Brachial plexus palsy and shoulder dystocia: obstetric risk factors remain elusive. Am J Perinatol 2013; 30 (04) 303-307
• 19 Iffy L, Pantages P. Erb's palsy after delivery by cesarean section. (A medico-legal key to a vexing problem.). Med Law 2005; 24 (04) 655-661
• 20 Poujade O, Azria E, Ceccaldi PF. , et al. Prevention of shoulder dystocia: A randomized controlled trial to evaluate an obstetric maneuver. Eur J Obstet Gynecol Reprod Biol 2018; 227: 52-59
• 21 Chauhan SP, Rose CH, Gherman RB, Magann EF, Holland MW, Morrison JC. Brachial plexus injury: a 23-year experience from a tertiary center. Am J Obstet Gynecol 2005; 192 (06) 1795-1800 , discussion 1800–1802
• 22 Leung TY, Stuart O, Sahota DS, Suen SS, Lau TK, Lao TT. Head-to-body delivery interval and risk of fetal acidosis and hypoxic ischaemic encephalopathy in shoulder dystocia: a retrospective review. BJOG 2011; 118 (04) 474-479
• 23 Leung TY, Stuart O, Suen SS, Sahota DS, Lau TK, Lao TT. Comparison of perinatal outcomes of shoulder dystocia alleviated by different type and sequence of manoeuvres: a retrospective review. BJOG 2011; 118 (08) 985-990
• 24 Hoffman MK, Bailit JL, Branch DW. , et al; Consortium on Safe Labor. A comparison of obstetric maneuvers for the acute management of shoulder dystocia. Obstet Gynecol 2011; 117 (06) 1272-1278
• 25 McLaren Jr RA, Chang KW, Ankumah NE, Yang LJ, Chauhan SP. Persistence of neonatal brachial plexus palsy among nulliparous versus parous women. AJP Rep 2019; 9 (01) 1-5
• 26 Stitely ML, Gherman RB. Shoulder dystocia: management and documentation. Semin Perinatol 2014; 38 (04) 194-200
• 27 Coroneos CJ, Voineskos SH, Coroneos MK. , et al; Canadian OBPI Working Group. Obstetrical brachial plexus injury: burden in a publicly funded, universal healthcare system. J Neurosurg Pediatr 2016; 17 (02) 222-229