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CC BY-NC-ND 4.0 · AJP Rep 2020; 10(01): e42-e48
DOI: 10.1055/s-0040-1705140
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Morgen S. Doty
1   Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
,
Suneet P. Chauhan
1   Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
,
Kate W.-C. Chang
2   Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
,
Leen Al-Hafez
3   Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas
,
Connie McGovern
2   Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
,
Lynda J.-S. Yang
2   Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
,
Sean C. Blackwell
1   Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
› Author Affiliations
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Publication History

31 October 2019

15 November 2019

Publication Date:
04 March 2020 (online)

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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
 

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