Incidence and prognosis of neonatal brachial plexus palsy with and without clavicle fractures

Lindley B. Wall, Janith K. Mills, Kenneth Leveno, Gregory Jackson, Lesley C. Wheeler, Scott N. Oishi, Marybeth Ezaki

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

OBJECTIVE:: To report the incidence of neonatal brachial plexus palsy with and without ipsilateral clavicle fracture in a population of newborns and to compare the prognosis between these subgroups. METHODS:: This was a retrospective review of 3,739 clavicle fractures and 1,291 brachial plexus palsies in neonates over a 24-year period from a geographically defined health care system with reference to county-wide population data. RESULTS:: A referral clinic for children with brachial plexus palsies evaluated 1,383 neonates, of whom 320 also had ipsilateral clavicular fracture. As a result of referral patterns within the region, it is likely that this represents nearly all infants from the area with persistent brachial plexus injury after 2 months of age. Among the children evaluated without concomitant clavicular fracture, 72% resolved spontaneously (154/214); among those with concomitant clavicular fracture, 74% healed spontaneously (55/74). Limiting the analysis to neonates delivered at Parkland Memorial Hospital and assuming that those neonates with a discharge diagnosis of brachial plexus injury with or without clavicular fracture who did not present to the referral brachial plexus injury clinic had complete resolution, 94.4% without clavicular fracture resolved and 98.1% with clavicular fracture resolved (P=.005). CONCLUSIONS:: The risk of persistent neurologic deficit from a birth-related brachial plexus palsy is lower than what has been reported, and the presence of a clavicle fracture may improve the likelihood of recovery.

Original languageEnglish (US)
Pages (from-to)1288-1293
Number of pages6
JournalObstetrics and Gynecology
Volume123
Issue number6
DOIs
StatePublished - 2014

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Clavicle
Brachial Plexus
Paralysis
Arm Injuries
Newborn Infant
Incidence
Referral and Consultation
Brachial Plexus Neuropathies
Neurologic Manifestations
Population
Parturition
Delivery of Health Care

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Incidence and prognosis of neonatal brachial plexus palsy with and without clavicle fractures. / Wall, Lindley B.; Mills, Janith K.; Leveno, Kenneth; Jackson, Gregory; Wheeler, Lesley C.; Oishi, Scott N.; Ezaki, Marybeth.

In: Obstetrics and Gynecology, Vol. 123, No. 6, 2014, p. 1288-1293.

Research output: Contribution to journalArticle

Wall, Lindley B. ; Mills, Janith K. ; Leveno, Kenneth ; Jackson, Gregory ; Wheeler, Lesley C. ; Oishi, Scott N. ; Ezaki, Marybeth. / Incidence and prognosis of neonatal brachial plexus palsy with and without clavicle fractures. In: Obstetrics and Gynecology. 2014 ; Vol. 123, No. 6. pp. 1288-1293.
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N2 - OBJECTIVE:: To report the incidence of neonatal brachial plexus palsy with and without ipsilateral clavicle fracture in a population of newborns and to compare the prognosis between these subgroups. METHODS:: This was a retrospective review of 3,739 clavicle fractures and 1,291 brachial plexus palsies in neonates over a 24-year period from a geographically defined health care system with reference to county-wide population data. RESULTS:: A referral clinic for children with brachial plexus palsies evaluated 1,383 neonates, of whom 320 also had ipsilateral clavicular fracture. As a result of referral patterns within the region, it is likely that this represents nearly all infants from the area with persistent brachial plexus injury after 2 months of age. Among the children evaluated without concomitant clavicular fracture, 72% resolved spontaneously (154/214); among those with concomitant clavicular fracture, 74% healed spontaneously (55/74). Limiting the analysis to neonates delivered at Parkland Memorial Hospital and assuming that those neonates with a discharge diagnosis of brachial plexus injury with or without clavicular fracture who did not present to the referral brachial plexus injury clinic had complete resolution, 94.4% without clavicular fracture resolved and 98.1% with clavicular fracture resolved (P=.005). CONCLUSIONS:: The risk of persistent neurologic deficit from a birth-related brachial plexus palsy is lower than what has been reported, and the presence of a clavicle fracture may improve the likelihood of recovery.

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