Erb's Palsy Research Articles

Early Conservative Physical Therapy Management of Babies With Obstetric Brachial Plexus Injury to Facilitate Spontaneous Recovery.

To evaluate the effect of early immobilization and proper handling techniques in infants with Obstetric Brachial Plexus Injury (OBPI) in the first 2weeks of life. Six 1-day-old infants (2 males and 4 females) with OBPI were included. The assessments were done at baseline, post-intervention, and 3-month follow-up, which involved a physical exam, Narakas classification, Active Movement Scale, and gross and fine motor skills evaluation. All infants had upper Erb's palsy. They had statistically significant improvement in the Active Movement Scale scores post-intervention with a large effect size. These improvements were maintained at follow-up. All infants achieved age-appropriate gross and fine motor skills with the affected upper limb at 3months of age. Early conservative physical therapy management had a statistically significant effect on enhancing spontaneous recovery and preventing further nerve injury in OBPI infants.

Shoulder external rotation contracture following neonatal brachial plexus injury

BackgroundGlenohumeral posterior external rotation contractures and scapular winging are frequently overlooked problems in residual neonatal brachial plexus injury (NBPI). Recent attention has emphasized their impact on vital functions such as feeding and hygiene. This study aims to present the epidemiology of posterior glenohumeral (GH) contractures in a significant pediatric NBPI population and explore contributing factors. MethodsWe conducted a retrospective analysis of data collected from January 2019 to November 2022, involving a case series of 262 children with residual NBPI. The data included demographics, palsy level, prior surgical history, and the modified Mallet scale. Glenohumeral passive internal rotation in abduction (IRABD) and cross-body adduction (CBADD) angles were measured bilaterally. Subjects were categorized into 'Belly-' (Mallet Hand-to-Belly <3) and 'Belly+' (Mallet Hand-to-Belly ≥3) groups. ResultsMedian participant age was 7.9 years (range: 3.5 – 21 years). Extension injury patterns included Erb's palsy (56.5%), extended Erb's palsy (28.6%), and global palsy (14.9%). Contractures exceeding 10, 20, and 30 degrees were prevalent in both IRABD and CBADD angles. The 'Belly-' group (9.5%) demonstrated a significant reduction in both angles compared to the 'Belly+' group. Weak correlations were found between IRABD (r=0.390, p<0.0001) or CBADD (r=0.163, p=0.0083) angles and Mallet hand-to-abdomen item. Glenohumeral reduction and Hoffer procedures led to a notable decrease in CBADD angle, without affecting 'Belly-' prevalence. Global injuries exhibited decreased angles compared to Erb's group. ConclusionsExternal rotation glenohumeral contractures are prevalent in residual NBPI, impacting midline access. Surprisingly, history of glenohumeral procedures or extensive injuries did not increase the likelihood of losing the ability to reach the belly. ROC analysis suggests specific thresholds for maintaining this ability.

Changing handedness after nerve reconstruction in brachial plexus birth palsy.

Right obstetric brachial plexus injuries (OBPI) often lead to left-handedness before limb function is restored post-surgery. A pertinent question arises about promoting a transition from left to right-handedness. We hypothesized that, with the decrease in neuroplasticity, handedness switching is not only difficult, but also reduces handedness-speech lateralization, impaired motor adaptability, and compromised language proficiency. We retrospectively analyzed clinical data from January 1996 to January 2012 at our hospital. Participants were divided into intervention or control groups based on handedness switching. We compared handedness and computed lateral quotient (LQ) and lateralization index (LI) for handedness-speech center. Additionally, we assessed dominant hand's writing speed, language function, and IQ. Associations between absolute LI and LQ values, writing speed, language scores, and IQ were examined. Nineteen extended Erb's palsy participants were enrolled, eight in the intervention group, and 11 in the control. No right-handed individuals were found in either cohort. The intervention group had significantly lower LQ and LI values, and fewer achieved normal writing speed. Yet, no notable disparities in language scores or IQ emerged. Notably, we established correlations between motor finesse, handedness degree, and handedness-speech lateralization. For right extended Erb's palsy, shifting handedness is nearly unfeasible, and such an endeavor could trigger a reduction in handedness-speech lateralization magnitude and diminished motor finesse.

Maternal and neonatal outcomes according to the timing of diagnosis of hyperglycaemia in pregnancy: a nationwide cross-sectional study of 695,912 deliveries in France in 2018.

We aimed to assess maternal-fetal outcomes according to various subtypes of hyperglycaemia in pregnancy. We used data from the French National Health Data System (Système National des Données de Santé), which links individual data from the hospital discharge database and the French National Health Insurance information system. We included all deliveries after 22 gestational weeks (GW) in women without pre-existing diabetes recorded in 2018. Women with hyperglycaemia were classified as having overt diabetes in pregnancy or gestational diabetes mellitus (GDM), then categorised into three subgroups according to their gestational age at the time of GDM diagnosis: before 22 GW (GDM<22); between 22 and 30 GW (GDM22-30); and after 30 GW (GDM>30). Adjusted prevalence ratios (95% CI) for the outcomes were estimated after adjusting for maternal age, gestational age and socioeconomic status. Due to the multiple tests, we considered an association to be statistically significant according to the Holm-Bonferroni procedure. To take into account the potential immortal time bias, we performed analyses on deliveries at ≥31 GW and deliveries at ≥37 GW. The study population of 695,912 women who gave birth in 2018 included 84,705 women (12.2%) with hyperglycaemia in pregnancy: overt diabetes in pregnancy, 0.4%; GDM<22, 36.8%; GDM22-30, 52.4%; and GDM>30, 10.4%. The following outcomes were statistically significant after Holm-Bonferroni adjustment for deliveries at ≥31 GW using GDM22-30 as the reference. Caesarean sections (1.54 [1.39, 1.72]), large-for-gestational-age (LGA) infants (2.00 [1.72, 2.32]), Erb's palsy or clavicle fracture (6.38 [2.42, 16.8]), preterm birth (1.84 [1.41, 2.40]) and neonatal hypoglycaemia (1.98 [1.39, 2.83]) were more frequent in women with overt diabetes. Similarly, LGA infants (1.10 [1.06, 1.14]) and Erb's palsy or clavicle fracture (1.55 [1.22, 1.99]) were more frequent in GDM<22. LGA infants (1.44 [1.37, 1.52]) were more frequent in GDM>30. Finally, women without hyperglycaemia in pregnancy were less likely to have preeclampsia or eclampsia (0.74 [0.69, 0.79]), Caesarean section (0.80 [0.79, 0.82]), pregnancy and postpartum haemorrhage (0.93 [0.89, 0.96]), LGA neonate (0.67 [0.65, 0.69]), premature neonate (0.80 [0.77, 0.83]) and neonate with neonatal hypoglycaemia (0.73 [0.66, 0.82]). Overall, the results were similar for deliveries at ≥37 GW. Although the estimation of the adjusted prevalence ratio of perinatal death was five times higher (5.06 [1.87, 13.7]) for women with overt diabetes, this result was non-significant after Holm-Bonferroni adjustment. Compared with GDM22-30, overt diabetes, GDM<22 and, to a lesser extent, GDM>30 were associated with poorer maternal-fetal outcomes.

Long-Term Hand and Shoulder Function in Children following Early Surgical Intervention for a Birth-Related Upper Brachial Plexus Injury.

Purpose To better understand the long-term hand and shoulder outcomes of upper brachial plexus birth injuries. Methods We evaluated shoulder and hand function in 32 patients (13 males; 19 females) with a C5/C6 birth injury history). All patients had undergone primary nerve surgery as infants, and 12 underwent a simultaneous shoulder procedure as they presented with a fixed internal rotation contracture of the shoulder. On average, all patients were evaluated and examined 15 years postoperatively. The shoulder function was evaluated using the Miami Shoulder Scale. Hand function was measured by the 9-hole peg test (9-HPT) and statistical analysis included comparison of 9-HPT time against normative data using the Student's t -test. Results The cohort includes 22 right-hand-dominant and 10 left-hand-dominant patients. Mean age at surgery was 10 months; mean age at follow-up was 15 years ± 2 years 2 months. Cumulative shoulder function was "good" or "excellent" (Miami score) in 23 patients. For 9-HPT, 23 out of 32 patients seen had an involved hand with a significant alteration in function. Conclusion Early nerve surgery in cases of upper brachial plexus birth injuries result in the desired outcome. To ensure timely and targeted therapy for any residual deficits, it is imperative that limitations in hand function among children with an Erb's palsy.

BIRTH INJURY, DUCHENNE-ERBʼS OBSTETRIC PALSY. DIAGNOSIS AND TREATMENT (LITERATURE REVIEW)

Obstetric practice dates back thousands of years, providing assistance to women in labor is often complicated by the rapid course of labor, pelvic presentation of the fetus, shoulder dystocia with a possible clavicle fracture. Damage to CV–CVI roots, classic Duchenne–Erb palsy, accounts for 46 % of the total number of obstetric palsies. Objective. To analyze the scientific and medical literature in order to identify historical scientific and practical information about the study of childbirth injuries, and, in particular, Duchenne–Erb's obstetric palsy. Methods. To study and analyze sources of scientific and medical information, publications from Google search engines, electronic databases PubMed, Google Scholar, archival medical journals. Results. The first data on obstetric paralysis were provided by Duchesne in 1872, highlighting thorough reports on upper extremity muscle damage. Subsequently, in 1874, Erb performed electrical stimulation of the affected muscles, finding out the zone of neurological damage. The history of the development and formation of this scientific issue is quite ambiguous, because it borders on two medical fields: neurosurgery and orthopedics. According to literary sources, it is obvious that the pathohistology and pathophysiology of the direct injury zone (roots CV–CVI), delayed changes in the function of the upper limb, and the latest diagnostic technologies simplify the understanding of the presentation. The existing methods of operative interventions allow physicians to improve the child's life. However, the question remains open regarding the use of certain operative interventions in relation to the child's age and further rehabilitation. Conclusions. Despite a significant stratum of scientific and practical research on Duchenne–Erb's obstetric palsy, there are still a number of questions regarding the diagnosis and treatment of children with this abnormality. The search for improving the functional state of the upper limb in children should continue.

Shoulder extension impairment with residual neonatal brachial plexus injury.

Impairment of both shoulder extension and behind-the-back function are common in patients with residual neonatal brachial plexus injury (NBPI), but have scarcely been studied or reported in the literature. Behind-the-back function is classically evaluated using the hand-to-spine task used for the Mallet score. Angular measurements of shoulder extension with residual NBPI have generally been studied utilizing kinematic motion laboratories. To date, no validated clinical examination method for this has been described. Intra-observer and inter-observer reliability analyses of two shoulder extension angles - passive glenohumeral extension (PGE) and active shoulder extension (ASE) - were performed. Afterwards, a retrospective clinical study was conducted on prospectively-collected data on 245 children with residual BPI treated from January 2019 through August 2022. Demographic characteristics, level of palsy, previous surgical procedures, modified Mallet score, and bilateral PGE and ASE data were analyzed. All inter- and intra-observer agreement was excellent, ranging from 0.82 to 0.86. Median patient age was 8.1 years (3.5-21). Among the 245 children, 57.6% had Erb´s palsy, 28,6% extended Erb's palsy, and 13,9% global palsy. One hundred sixty-eight (66%) of the children could not touch their lumbar spine, among whom 26,2% (n=44) had to swing the arm to reach it. Both the degrees of ASE and PGE achieved correlated significantly with the hand-to-spine score, the ASE strongly (r=0.705) and the PGE weakly (r=0.372; both p<0.0001). Significant correlations also were found between lesion level and the hand-to-spine Mallet score (r=-0.339, p<0.0001) and ASE (r=-0.299, p<0.0001) and between patient age and the PGE (p=0.0416, r=-0.130). A statistically significant decrease in PGE and incapacity to reach the spine were found in patients who underwent glenohumeral reduction, shoulder tendon transfer, or humeral osteotomy, relative to those who had microsurgery or no surgery. Receiver operating curves (ROC) showed that, for both PGE and ASE, the the minimum extension angle required to successfully perform the hand-to-spine task was 10 degrees, with sensitivity levels of 69.9 and 82.2, and specificity levels of 69.5 and 87.8 (both p<0.0001), respectively. Glenohumeral flexion contracture and lost active shoulder extension are extremely common in children with residual NBPI. Both the PGE and ASE angles can be measured reliably with a clinical exam, with at least 10 degrees of PGE and ASE necessary to perform the hand-to-spine Mallet task. Level IV; Case Series; Prognosis Study.

Initial Challenges and Opportunities for the Parents of Children Born with ERB's Palsy in Rural and Urban Areas of Punjab, Pakistan

Initial Challenges and Opportunities for the Parents of Children Born with ERB's Palsy in Rural and Urban Areas of Punjab, Pakistan

Severe neonatal birth injury: Observational study of associations with operative, cesarean, and spontaneous vaginal delivery.

To determine the association of successful and unsuccessful operative vaginal delivery attempts with risk of severe neonatal birth injury. We conducted a population-based observational study of 1 080 503 births between 2006 and 2019 in Quebec, Canada. The main exposure was operative vaginal delivery with forceps or vacuum, elective or emergency cesarean with or without an operative vaginal attempt, and spontaneous delivery. The outcome was severe birth injury, including intracranial hemorrhage, brain and spinal damage, Erb's paralysis and other brachial plexus injuries, epicranial subaponeurotic hemorrhage, skull and long bone fractures, and liver, spleen, and other neonatal body injuries. We determined the association of delivery mode with risk of severe birth injury using adjusted risk ratios (RR) and 95% confidence intervals (CI). A total of 8194 infants (0.8%) had severe birth injuries. Compared with spontaneous delivery, vacuum (RR 2.98, 95% CI 2.80-3.16) and forceps (RR 3.35, 95% CI 3.07-3.66) were both associated with risk of severe injury. Forceps was associated with intracranial hemorrhage (RR 16.4, 95% CI 10.1-26.6) and brain and spinal damage (RR 13.5, 95% CI 5.72-32.0), while vacuum was associated with epicranial subaponeurotic hemorrhage (RR 27.5, 95% CI 20.8-36.4) and skull fractures (RR 2.04, 95% CI 1.86-2.25). Emergency cesarean after an unsuccessful operative attempt was associated with intracranial and epicranial subaponeurotic hemorrhage, but elective and other emergency cesareans were not associated with severe injury. Operative vaginal delivery and unsuccessful operative attempts that result in an emergency cesarean are associated with elevated risks of severe birth injury.

Effect of Mirror Therapy on Fine Manual Control in Children with Erb's Palsy

Effect of Mirror Therapy on Fine Manual Control in Children with Erb's Palsy

The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination.

The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination.

Predictors of Co-activation in Erb's Palsy: A Retrospective Study.

Three per thousand births have Erb's palsy. Spontaneous recovery is 50%. Co-activation yields poor outcomes. There are no objective indicators of its emergence. Analyze if 1 month Axon Viability Index (AVI) of the axillary nerve and which active movement score (AMS) measures can predict co-activation. Tertiary level rehabilitation center, retrospective design. The electronic medical record (EMR) was reviewed for patients with Erb's palsy with Narakas grade 2 lesions, as having co-activation or not. The one-month Axillary AVI was used with monthly AMS scores. The inclusion criteria were an AVI greater than ten percent. Exclusion criteria were bi-brachial palsy, congenital anomalies, concomitant or subsequent neurological injuries, and orthopedic injuries. Descriptive statistics were used to calculate the median and interquartile values for AMS scores at each respective time point. Statistical significance for each time point was determined using a student's t-test. Regarding the t-test on the AVI data, a significant P value of 0.001 was found favoring the co-activation group. AVI of the Axillary nerve between 0.1 and 0.5 at 1 month is a reliable indicator of future development of co-activation. The following were strong indicators of the emergence of co-activation respectively: month three Wrist Extension in sitting, Shoulder Abduction in supine, Shoulder Abduction in sitting, Elbow Flexion in sitting, month six Elbow Flexion in sitting, month seven Elbow Flexion in sitting. The axillary AVI at one month is a good predictor of future development of co-activation. The mentioned AMS items are the earliest indicators of co-activation.

Art and Pediatric Orthopaedics: "Arm-twisting" by Wyspianski, the Poet, Actor, and Artist.

Stanislaw Wyspianski, a multifaceted Polish artist painted "A Girl with a Red Hat", which portrays a young girl with an obviously deformed right upper limb. The pattern of deformities is suggestive of either athetoid hemiplegic cerebral palsy or Erb's palsy.

NEONATAL OUTCOME IN INFANTS OF DIABETIC MOTHERS

Introduction The prevalence of diabetes is increasing globally . 3 to 5 % of all pregnant women show glucose intolerance. Approximately 90% of these women have GDM.Infants born to diabetic mothers are prone to complications like congenital malformations and metabolic abnormalities.Most of these complications depend on maternal glycemic control which can be prevented by good periconceptional and prenatal care. Aims and objectives This study is taken up to evaluate complications occurring in infants of diabetic mothers and also to compare the outcome of infants of preGDM mothers and GDM mothers Methodology This is hospital based observational study done on infants of diabetic mothers admitted in NICU, KGH, Visakhapatnam Neonates of diabetic mothers who have other complications like heart disease, PIH, Pre eclampsia, twin gestation, etc. which may effect the baby adversely are excluded from study Results A total of 50 neonates are studied out of whom 37 neonates are born to mothers with gestational diabetes and 13 to mothers with overt diabetes . Mean birth weight of infants of GDM is 3.7kg. Hypoglycemia is more common in infants of GDM mothers than in overt DM. Congenital anamolies are seen in 14% of babies. Birth injures including clavicle fracture , erb's palsy are seen in 5 babies, all of then weighed &gt;3.5kg and delivered by assisted vaginal delivery. Conclusion Macrosomia,birth injuries and metabolic complications are common in infants of GDM mothers than in infants of pre GDM mothers.This shows importance of timely screening of all pregnant women for GDM and counsel them regarding importance of glycemic control to prevent neonatal complications.

Effect of Reciprocal Electrical Stimulation in Erb's Palsy Children

Effect of Reciprocal Electrical Stimulation in Erb's Palsy Children

Head position and vacuum-assisted delivery using the Kiwi Omnicup.

To evaluate the association between fetal head position during prevacuum assessment and adverse outcomes. This retrospective cohort study included all vacuum-assisted deliveries using the Kiwi Omnicup over 5 years. Primary outcomes were third- or fourth-degree perineal tear, pH < 7.1, and subgaleal hematoma (SGH). AGAR, neonatal intensive care unit admission, cephalohematoma, Erb's palsy, third-stage duration, and postpartum hemorrhage were secondary. Outcomes were compared between the occiput posterior (OP) and occiput anterior (OA) positions. The study included 1960 patients. OP position was more likely to involve epidural analgesia (311 [82.5%] vs. 1216 [77%], P= 0.020), higher fetal head station (P= 0.001), higher percentage of cup detachments (121 cases [32.1%] vs. 307 [19.4%], P= 0.001), and longer procedure (5.5 ± 3.7 min vs. 4.7 ± 2.8 min, P= 0.001). OP was associated with umbilical cord pH< 7.1 (21 [5.5%] vs. 52 [3.9%], P= 0.032), NICU admissions (16 [4.2%] vs. 38 [2.4%], P= 0.049), SGH (18 [4.8%] vs. 38 [2.4%], P= 0.013), and high-degree perineal tears (12 [3.2%] vs. 26 [1.7%], with borderline significance, P= 0.051). SGH and high-grade tears remained significantly associated with OP position (P= 0.008 and P= 0.016, respectively) after adjusting for maternal age, nulliparity, diabetes, epidural anesthesia, preprocedure head station, and birth weight. OP position is an independent risk-factor for anal sphincter injury and SGH during vacuum-assisted delivery.

Clavicular Fractures in Newborns: What Happens to One of the Commonly Injured Bones at Birth?

IntroductionThe clavicle is one of the most commonly injured bones during the birth process. The objective of this study was to determine the frequency and outcome of fractured clavicle amongst neonates born in a five-year period at a Secondary Hospital setting and to determine the Maternal and Neonatal Characteristics involved in such cases and compare them with a control group and determine the significance of any factors.MethodsAll cases of fractured clavicle were retrospectively reviewed in a Secondary care hospital setting during a five-year period from July 2015 to June 2020. Maternal and neonatal factors were determined and then compared to a control group.ResultsOut of 21,435 live births at our center during the study period, 92 infants were diagnosed to have clavicle fractures, giving an incidence of 4.29 per 1,000 live births (0.43%). 89% cases (n=82) were detected before discharge and 11 % cases (n=10) on routine follow-up visit after discharge. Physical examination identified 77% cases (n=71) whereas 23% cases (n=21) were recognized incidentally on X-ray. All babies with fracture including 3 with Erb’s palsy recovered completely without any complications. On logistic regression analysis, spontaneous vaginal delivery, prolonged second stage, vertex presentation, vitamin D deficiency in mothers, birthweight, macrosomia, all were significant risk factors.ConclusionNeonatal clavicular fracture appears to be a transient yet unpredictable and unavoidable event with an overall good prognosis. Only the birth weight was identified as the common risk factor affecting clavicular fracture. Parental concerns and anxiety can be decreased with proper counselling and reassurance.

PRELIMINARY STUDY OF OBSTETRIC PARALYSIS OF THE BRACHIAL PLEXUS AT THE NATIONAL CENTRE FOR DISABLED PERSONS IN YAOUNDE, CAMEROON, ABOUT A COHORT OF 15 CASES: FREQUENCY, PHYSIOTHERAPY TECHNIQUES AND SHORT-TERM RESULTS OF CONSERVATIVE TREATMENT IN A RESOURCE-LIMITED COUNTRY

Background: Neonatal brachial plexus palsis (NBPP) is a childbirth-related trauma whose frequency, risk factors, clinical forms and outcomes of physiotherapy techniques that can be used in our context are not known. Method: This cohort study took place from June 1 to August 30, 2016. The incidence was determined at the Main Maternity Hospital of the Central Hospital of Yaounde. The cohort of patients selected was evaluated at the National Centre for the Rehabilitation of Disabled Persons before and after physiotherapy. The physiotherapy techniques used were identical, 3 times a week for 3 months, for all children: stimulation, mobilization, immobilization, in addition to home exercises. Results: The incidence of NBPP was 3%. The most frequent risk factors in the 15 cases were: low maternal socio-educational level (73.33%), low parity (53.33%), childbirth in a peripheral health facility (60%), weight gain over 15 kilograms during pregnancy (73.33%) and macrosomia (73.33%). We had 15 NBPPs, 73.33% on the leftt upper arm and 60% in girls. The average age of the children was 29.93[2-182] weeks. The mothers average age was 29.33[19-35] years at the time of birth. The proximal forms or the Erb type (80%), were the most represented followed by the total forms ( 20%). Torontos average score before and after physiotherapy increased from 5.66[1-11] to 9.66[3-16] out of 21. We had 10 (66.66%) improvements, in the short term concerning the proximal forms. Conclusions: We had some good results with physiotherapy techniques applicables in developping countries for the Erb palsy which is the most frequent NBPP. This is why we recommend physiotherapy first and surgery if failure after 3 months, if larger studies confirm our data.

Traumatic Brachial Plexus Palsy in Children: Long-Term Outcome and Strategy of Reconstruction.

Traumatic brachial plexus injuries in children represent a definite spectrum of injuries between adult and neonatal brachial plexus injuries. Their characteristics have been scarcely reported in the literature. The priority of functional restoration is not clear. In total, 52 children with surgically treated traumatic brachial plexus injuries, excluding Erb's palsy, were reviewed after a minimum follow-up of 2 years. All children except nine were males, with an average age at surgery of 8 years. Forty-five children had exclusive supraclavicular plexus injuries. Twenty-one of them (46%) had two or more root avulsions. Seven children (13.5%) had infraclavicular plexus injuries. Time from trauma to surgery varied from 1 to 15 months (mean = 4.7 months). Extraplexal neurotization was the most common surgical technique used. Shoulder abduction and external rotation were restored to an average of 83 and 26 degrees, respectively. Elbow flexion and extension were restored to grade ≥3 in 96 and 91.5% of cases, respectively. Finger flexion and extension were restored to grade ≥4 in 29 and 32% of cases, respectively. Wrist flexion and extension were restored to grade ≥4 in 21 and 27% of cases, respectively. Results of neurotization were superior to those of neurolysis and nerve grafting. Among the 24 children with insensate hands, 20 (83.3%) recovered S3 sensation, 3 recovered S2, and 1 recovered S1. No case complained of neuropathic pain. Functional recovery correlated negatively but insignificantly with the age at surgery and time from injury to surgery. Brachial plexus injuries in children are associated with a high incidence root avulsions and no pain. Neurotization is frequently required and the outcome is not significantly affected by the delay in surgery. In total plexus injuries, some useful hand function can be restored, and management should follow that of obstetric palsy and be focused on innervating the medial cord.

385 Head injuries related to birth trauma during vacuum extraction in low birth-weight neonates

To evaluate the impact of vacuum extraction on neonatal head injuries related to birth trauma, among new-borns with low birth weight (BW) (<2,500 g) using a non-metal vacuum cup. Retrospective cohort study of 3335 women with a singleton pregnancy, ≥34 gestational weeks delivered by a vacuum extraction, between 2014 and 2019. The current study compared head injuries related to birth trauma, and rates of other neonatal complications of 207 (6.2%) neonates with a BW < 2,500 g to 3128 (93.8%) neonates with higher BW, divided into three subgroups (2,500-2,999g, 3,000-3,499g, ≥3,500g) The lowest rates of subgaleal hematomas occurred in neonates with low BW < 2,500g (0.5%) and increased with every additional 500 g of neonatal weight (3.2%, 4.4% and 7.6% in 2,500-2,999g, 3,000-3,499g, ≥3,500g groups respectively, p=0.001). Cephalohematomas were also significantly lower among low BW neonates (0.5% in <2,500gs BW) and increased with every additional 500 g to BW (2.6%, 3.3% and 3.8% in 2,500-2,999g, 3,000-3,499g, ≥3,500g groups respectively, p=0.026). Primary Composite Neonatal Outcome – including head injuries related to birth trauma, fractures of humerus or clavicle and erb's palsy- increased with increasing weight as well (1% among neonates weighing < 2,500g, versus 6.2%, 8.2% and 13.6% in 2,500-2,999g, 3,000-3,499g, ≥3,500g groups respectively, p=0.000). Logistic regression found increasing neonatal weight as a risk factor for subgaleal hematoma and cephalohematoma during vacuum assisted vaginal deliveries. NICU hospitalization rates were highest among neonates weighing <2,500 g (10.1%) compared to the other groups (2.7%, 1.7% and 3.3% in 2,500-2,999g, 3,000-3,499g, ≥3,500g respectively, p=0.000). Vacuum extraction of neonates weighing <2500 g at 34 weeks and beyond seems to be a safe mode of delivery when indicated, with lower rates of head injuries related to birth trauma compared to neonates with higher birth weights.View Large Image Figure ViewerDownload Hi-res image Download (PPT)