Neonatal Clavicular Fracture Research Articles

Neonatal clavicular fracture: Can induction of labor be a risk factor?

Perinatal clavicular fracture is the most common birth injury that may cause neonatal morbidities such as obstetric brachial palsy (OBP) ranging from 0.2 to 3.5%. We aimed to compare the relationship between perinatal clavicular fracture and induced vaginal delivery. All the live births and the neonatal outpatient clinic admissions between June 2016 and December 2022 have been investigated retrospectively. A total of 185 newborn infants with a mean gestational age of 38.3±1.6 weeks and a mean birth weight of 3,451±430.10 grams were enrolled. When compared to all in-born live births, the overall incidence of clavicular fracture was 0.78%. One hundred eighty-one (97.8%) infants were born vaginally and 4 (2.2%) were born by cesarean sections (C-sections). The incidence of clavicular fracture among in-born vaginally delivered infants was 1.26% (n=153) and among C-section deliveries was 0.04% (n=3). In vaginal deliveries, 54.7% (n=99) had prolonged labor, 71.8% (n=130) had received labor induction and 7.7% (n=14) had a history of instrumental intervention. A statistically significant relationship was found between clavicular fracture and prolonged labor, labor induction, increased birth weight, and low Apgar scores (p<0.001). While 21 infants (11.4%) had cephalohematoma, 8 infants (4.3%) presented with symptoms of OBP. Although high birth weight, prolonged labor, and ventouse delivery are the already known major risk factors for neonatal clavicular fractures, induced vaginal delivery has been defined as a new and important risk factor. Induction of labor should be decided when the benefits of immediate delivery outweigh the risks of continuing the pregnancy for fetal and maternal health.

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.

Isolated neonatal clavicular fracture is a risk factor for future shoulder dystocia

Objective Shoulder dystocia (SD) is a risk factor for neonatal clavicular fracture (CF). Previous SD is a known risk factor for subsequent SD. It is unknown whether an isolated neonatal CF (one that is not associated with SD) increases the risk of future SD. We aimed to investigate this question. Methods A retrospective computerized database study conducted at Shaare Zedek Medical Center, a university-affiliated hospital, between 2005 and 2018. We included in the study all women that had a vaginal delivery without SD and had a subsequent vaginal delivery in our center between 2005 and 2018. Medical records of parturients who had a coded diagnosis of neonatal CF were retrieved. The first delivery with the neonatal diagnosis of an isolated CF was chosen as index delivery. Rates of SD at the subsequent delivery were assessed and compared between parturients with isolated neonatal CF (INCF) and parturients without neonatal CF or SD at the index delivery. To account for dependency between deliveries of the same individual parturient, we used generalized estimating equation (GEE) models. Results We identified 39,601 parturients that met the inclusion criteria. During the study period, 519 parturients with a diagnosis of INCF that had at least one subsequent delivery were identified (1.3%). Overall, 3.9% of parturients with isolated CF (20/519) had subsequent SD, as compared to 0.5% of parturients without CF or SD at the index delivery (190/39082; p < .01). Previous diagnosis of INCF was found to be independently associated with SD in a subsequent delivery after controlling for known risk factors for SD (aOR = 6.41, 95% CI = 3.92–10.61). Previous diagnosis of an INCF was also found to be independently associated with a subsequent event of SD in all subsequent deliveries of the same individual parturient (aOR = 3.42, 95% CI = 2.26–5.18). Conclusion Women with previous INCF have an increased risk for SD in subsequent deliveries. Intervention efforts directed at this particular subgroup of women should be applied, with special attention to potentially modifiable risk factors to minimize the risk for future SD.

Discuss the prevention and nursing strategies of clavicular fracture in newborn

Objective To summarize the reasons of clavicular fracture in newborn, discuss strategies on the prevention and nursing treatment . Methods Review and analyze etiopathogenisis of 23 cases with clavicular fracture in newborn from January 2017 to December 2019 in Dongguan People's Hospital (China) and discuss their nursing treatment methods. Results Causes of clavicular fracture in newborn are mostly due to shoulder dystocia and a small part of that result from the birth process anomalies or negligence of medical personnel. All children of clavicle fractures in newborn partially fixed affected limb, can reach clinical cure after six weeks. Conclusion Correctly assessing the fetal weight, selecting the appropriate mode of parturition, proper handling the birth process anomalies, and establishing a good sense of responsibility with medical personnel can reduce the incidence of clavicular fracture in newborn. Neonatal clavicular fracture after a short partial brake can completely heal without sequela.

1074: Isolated neonatal clavicular fracture - is it a risk factor for future shoulder dystocia?

1074: Isolated neonatal clavicular fracture - is it a risk factor for future shoulder dystocia?

Risk Variables of Neonatal Clavicular Fracture and the Role of Ultrasound in Its Diagnosis

Risk Variables of Neonatal Clavicular Fracture and the Role of Ultrasound in Its Diagnosis

706: Outcomes of routine shoulder dystocia screening using a commercially available screening tool

A sensitive prediction model to aid the identification of women at risk of shoulder dystocia has remained elusive thus far. A proprietary tool known as the PeriCALM Shoulder Screen (PeriGen, Princeton, NJ) has been suggested in observational data to identify at-risk patients through a composite of historical, demographic, and medical factors. This study sought to investigate the effects of routine use of the Shoulder Screen in a community hospital. This was a retrospective review of all deliveries from January 2012 through December 2012 at a residency-affiliated community hospital. The Shoulder Screen has been routinely performed by nearly half of the providers delivering at this hospital since 2011. Analysis was limited to pregnancies of at least 36 weeks' gestation and eligible for vertex vaginal delivery. Of 1,793 eligible pregnancies, 738 (41%) underwent the screening process. Those screened were younger, be of non-white race, and have a higher BMI. The odds of shoulder dystocia were similar between women in the screened and unscreened groups (2.57% vs 2.56%; odds ratio, 0.96; 95% CI: 0.52-1.77). The rates of cesarean delivery (23.3% vs 24.5%, P = 0.38), operative vaginal delivery (4.3% vs 5.6%, P = 0.23), brachial-plexus injury (0.27% vs 0%, P = 0.09), admission to the neonatal intensive-care unit (8.7% vs 8.8%, P = 0.92), and low five-minute Apgar scores (0.41% vs 0.28%, P = 0.66) were also similar. There were statistically significantly decreased incidences of episiotomy (4.5% vs 8.1%, P = 0.003) and severe perineal laceration (1.1% vs 2.6%, P = 0.026) in the unscreened group as well as an increased risk of neonatal clavicular or humeral fracture (0.41% vs 0%, P = 0.038). Use of the Shoulder Screen, while not affecting the cesarean rate, did not reduce the incidence of shoulder dystocia. The differences in maternal and neonatal outcomes may be attributed to the effect of screening or variations in provider practice.

Neonatal clavicular fracture: Recent 10 year study

The clavicle is the bone most frequently fractured during the delivery process. A retrospective review was performed of all births with clavicular fractures from January 2003 to December 2012. Risk factors for fracture were determined and then compared to the control group. The data were compared and analyzed with previous studies. Three hundred and nineteen cases of clavicular fracture (0.41% of total live births, n = 77 543) were identified. Prior to discharge, 275 cases (86.2%) were detected, and 44 cases (13.8%) were not detected until after discharge. Physical examination identified 144 cases (45.1%), while 175 cases (54.9%) were identified on chest X-ray incidentally. All babies with fracture, including five (1.6%) with brachial plexus palsy, recovered without treatment. Vacuum delivery was associated with a significantly higher incidence of clavicular fracture, as were mothers of advanced age with relatively shorter height. High birthweight, low head to chest circumference ratio and low Apgar score were other variables also significantly associated with clavicular fracture. On logistic regression analysis vacuum delivery and birthweight were significant risk factors. When analyzing and comparing findings from previous studies, only birthweight was identified as common to the risk factors affecting clavicular fracture. Major risk factors for clavicular fracture were vacuum delivery and birthweight. Considering the previous studies together, neonatal clavicular fracture appears to be a transient event without sequelae and most probably not preventable during birth.

Reappraisal of Neonatal Clavicular Fracture: Relationship Between Infant Size and Neonatal Mortality

Reappraisal of Neonatal Clavicular Fracture: Relationship Between Infant Size and Neonatal Mortality

Reappraisal of Neonatal Clavicular Fracture: Relationship Between Infant Size and Neonatal Mortality

Department of Obstetrics and Gynecology Princess Margaret Hospital Lai King Hill Road Lai Chi Kwok, Kowloon Hong Kong, Republic of China

Reappraisal of Neonatal Clavicular Fracture

Reappraisal of Neonatal Clavicular Fracture

Reappraisal of neonatal clavicular fracture: relationship between infant size and neonatal morbidity

Objective: To examine the extent of neonatal morbidity and its relation with infant size in newborns diagnosed with clavicular fracture after vaginal birth. Methods: A retrospective case-control study was performed on all the infants diagnosed with clavicular fractures and born vaginally between July 1997 and June 2000. For each index case, a control matched for gestational age (within l week), birth weight (within 100 g), and delivered within the same 24-hour period (8 am to 8 am), was selected at random from the delivery suite registry. If a control could not be identified within the period, the search was extended to the previous or the following 24-hour period, and the birth weight criterion relaxed to within 250 g. The overall neonatal outcome was compared between the two groups and the morbidity was further analyzed according to whether the infants were large for gestational age (LGA) or not. Results: Clavicular fracture, found in 1.6% (151 of 9540) of vaginal births, was associated with increased incidence of instrumental delivery ( P = .001) and shoulder dystocia ( P = .013). The associated morbidity were Erb palsy ( P = .007), which was more often found in the LGA infants ( P = .055), and cephalhematoma ( P = .031), which was only found in the non-LGA infants (odds ratio 4.48, 95% confidence interval 1.23, 16.30). On multivariable analysis, clavicular fracture was excluded as a significant factor in these outcomes after adjusting for the effect of instrumental delivery and shoulder dystocia. Conclusion: Neonatal clavicular fracture is of little clinical significance, and it does not reflect quality of care.

Neonatal clavicular fracture: clinical analysis of incidence, predisposing factors, diagnosis, and outcome.

The objective of this study is to identify maternal, perinatal, and fetal risk factors for clavicular fracture in a single institution. We performed a prospective study of all deliveries during a 14-month period to identify confirmed cases of neonatal clavicular fracture. The control group consisted of the deliveries immediately preceding and following the index cases. Fifty-three cases of clavicular fracture were identified among the 4789 deliveries from October 1995 through November 1996 for an incidence of 1.11%. Three neonates in the clavicular fracture group were delivered through cesarean section. Neonates with fracture were significantly heavier at birth than those without (3564 vs. 3283 g, p <0.001), and had a lower mean head-to-abdominal circumference ratio (0.93 vs. 1.08, p <0.001), history of giving birth to a macrosomia (21 vs. 4%, p <0.05). The anterior shoulder was the predominant site of fracture (30/53). Fracture was detected mostly during the first 3 days of neonatal life (46/53). The outcome was benign, with complete recovery in all cases and no associated neurological sequelae. Neonatal clavicular fracture tended to be associated with neonatal somatometric characteristics and difficult deliveries. Considering the benign nature of this birth trauma, more invasive intrapartum management to lower its incidence is not advised.

Palpable spongy mass over the clavicle, an underutilized sign of clavicular fracture in the newborn.

This prospective study emphasizes the importance of an early physical finding of neonatal clavicular fracture, termed "the palpable spongy mass sign." Of the 1,661 term neonates examined at our tertiary center over a 20-month period, 24 had clinical signs of a clavicular fracture. In 22 of the 24 neonates, the fractures were documented by positive radiographs or callus formation. None of the fractures was recognized because of an asymmetric Moro reflex, visible swelling, or bruising. The palpable spongy mass was present in 18 of the 22 fractures (82%), crepitus in 10 (45%), angulation deformity in two (9%), and localized tenderness in one (5%). Any combination of crepitus, deformity, and localized tenderness was detected in 11 of the 22 (50%) fractures. When the palpable spongy mass sign was added to these three signs, all but one fracture was clinically detected (95%), emphasizing the importance of using all physical findings. We conclude that "the clavicular spongy mass sign" is highly sensitive and predictive of neonatal clavicular fractures.

Fracture of the clavicle in the newborn following normal labor and delivery

Objective: Earlier works have associated neonatal clavicular fracture (0.2–3.5% of all deliveries) with a range of procedural, fetal and maternal risk factors; more recent studies, however, have failed to firmly identify any one or a combination of them. In the present work we sought to determine possible ante/intra-partum risk factors for this condition. Study design: Using a retrospective case-controlled approach, we examined a series of maternal, fetal and pregnancy or delivery-related variables in 87 cases (out of 403) of fractured clavicle of the newborn diagnosed in our department from 1986 to 1994. All infants were delivered vaginally (in the occipito-anterior position) at term by a specialist obstetrician and underwent peripartum sonographic fetal weight estimation. All variables were compared with those of an equal number of infants born immediately before or after each affected infant and delivered by the same obstetrical team. Results: Fractured clavicles were found in 1.65% of the total number of deliveries during the study period. Neonatal clavicular fracture was significantly and directly related to the duration of the second stage of labor, peripartum sonographic fetal weight estimation, and neonatal length, and inversely related to maternal height; nevertheless, all values in both the study and control groups were within normal range. Logistic regression analysis showed that these antenatal variables significantly affect the chances of clavicular fracture, but due to the high false-positive rate they cannot serve clinically as a comprehensive antenatal prediction index. Conclusions: The majority of clavicular fractures occur in normal newborns following normal labor and delivery. The risk factors we identified statistically do not offer a method for clinical prenatal prediction. This work provides statistical evidence of the nature of this complication of early newborn life.

Obstetric clavicular fracture: The enigma of normal birth

To determine the main risk factors involved in neonatal clavicular fracture, the most common injury to the neonate. Two hundred fifteen cases of clavicular fracture of 65,091 vaginal deliveries (0.4%) occurring between January 1983 and December 1988 were pair-matched with controls based on mode and date of delivery, race, and maternal age. Incidences, odds ratios, and stratified analysis were used to identify and control for confounding between risk factors. Shoulder dystocia, increasing birth weight, and increasing gestational age were identified as risk factors. Within the range of normal birth weights, there is a biologic gradient of increasing risk for clavicular fracture. Although shoulder dystocia is the strongest risk factor identified, the magnitude of its point estimate is probably affected to a large extent by differential ascertainment. The use of forceps, prolonged second stage of labor, and nulliparity status were not significantly associated with neonatal clavicular fracture. Neonatal clavicular fracture occurs commonly in an obstetric population. Obstetric clavicular fracture is an unpredictable, unavoidable complication of normal birth.