69: Neonatal brachial plexus injury: comparison of incidence and antecedents between two time periods

Abstract

Neonatal brachial plexus injury (BPI) is readily apparent on clinical examination and is most commonly a consequence of shoulder impaction at vaginal delivery. After an institutional analysis of BPI in 1994 – 1998 [1] showed an incidence of 1.5/1000 births, specific staff training in management of shoulder dystocia was introduced with a view to avoiding BPI. We describe a re-evaluation of recent cases of BPI following these measures. All infants with neonatal evidence of BPI were prospectively identified during 2004 – 2008. Injuries were categorized as transient or persistent (neurological impairment persisting beyond 1 year), correlated with maternal details and intrapartum events and compared with the earlier reported series. Of 41,828 deliveries from 2004 – 08, there were 72 cases of BPI identified (1.7/1000), compared to 54 cases (1.5/1000) from 1994 – 98. (p =0.4); 9 cases (12.5%) were persistent in 2004 – 08, compared with 10 cases (18.5%) in 1994 – 98. (p =0.4). Instrumental delivery was a significantly commoner antecedent in 2004 -08 than in 1994 – 1999 (55% vs. 13%; p<0.001). There was no significant difference between the two time periods in respect of maternal parity, obesity/gestational weight gain or prolonged pregnancy. The proportion of birthweights greater than 4.0kg was also identical at 19%, although the cesarean section (CS) rate had increased from 10.7% to 18.4%. Four cases (6%) in 2004-08 occurred following CS compared with 1 (2%) earlier case. Despite specific staff training to counter shoulder dystocia and a rising institutional CS rate, the incidence of both transient and persistent BPI has remained virtually unchanged compared with 10 years earlier.