Our newborn cases with brachial plexus palsy and its prognosis relation with clavicle fracture: A single-center retrospective study

Aim: The aim of the study was to present clinical and demographic characteristics of the newborns born in our hospital via normal vaginal delivery and diagnosed with obstetric brachial plexus palsy (OBPP).Material and Methods: Our study was planned as a retrospective single-center study. In our study, newborns born with normal vaginal route were included in Malatya Training and Research Hospital between October 1, 2015 and March 15, 2018. In this period, a total of 5288 newborns were born and 68 of these cases had the pathology of OBPP.Results: Of 68 patients with OBPP, 37 were girls, 31 were boys and mean birth weight was 3,888 gr. The right arm of 38 cases and the left arm of 31 cases were found to develop OBPP. According to the Narakas classification, 39 cases of them (57.3%) were stage I, 21 (30.8%) were stage II, 6 (8.8%) were stage IIU, and 2 of the cases (2.9%) were evaluated as stage IV.Discussion: In our study, the mean frequency of OBPP was close to the world average. Even, it was lower comparing to some European countries. However, the frequency of clavicular fracture was higher comparing to the literature. This gave the impression that the clavicle fracture could be considered as a protecting factor for the development of OBPP.Conclusion: Although OBPP is a common congenital complication in newborns, its frequency in Turkey is parallel to the world average. The main reasons for this OBPP outcome can be due to increasing the number of highly skilled obstetricians in this field and women are currently performing most of the deliveries in a hospital setting even they are not under follow-up. In addition, the protective effect of clavicle fracture on OBPP was also observed in our study.

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1. Chauhan SP, Blackwell SB, Ananth CV. Neonatal brachial pleksus palsy: Incidence, prevalence, an temporal trends. Semin Perinatol 2014;38:210-8.
2. Ouzounian JG. Risk factors for neonatal brachial plexus palsy. Semin Perinatol 2014;38:219-21.
3. Leblebicioğlu G. Brakial Pleksus Yaralanmaları. Türk Nöroşirurji Dergisi 2003;15:227-49.
4. Backe B, Magnussen EB, Johansen OJ, et al. Obstetric brachial plexus palsy: a birth injury not explained by the known risk factors. Acta Obstet Gynecol Scand 2008;87:1027-32.
5. Foad SL, Mehlman CT, Ying J. The epidemiology of neonatal brachial plexus palsy in the United States. J Bone Joint Surg Am 2008;90:1258-64.
6. Doğum istatistikleri 2001-2008 sonucları. T.C Başbakanlık Turkiye İstatistik Kurumu Haber Bulteni, 2009:180.
7. Narakas AO. Obstetrical brachial pleksus injuries. In: Lamb DW, ed, The Paralysed Hand. The Hand and Upper Limb. Edinburgh Lothian; New York, NY, Churchill Livingstone 1987;116-35.
8. Oral E, Çagdas A, Gezer A, et al. Perinatal and maternal outcome of fetal macrosomia. Ein J Obstet Gyne¬col Reprod Biol 2001;99:167-71.
9. Goldie BS, Coates CJ. Bracial plexus injury: A survey of in¬cidens and referral pattern. J Hand Sung Br 1992;17:86-8.
10. Gilbert A. Longterm evaluation of brachial plexus surgery in obstetrical palsy. Hand Clin 1995;11:583-94.
11. Walsh JM, Kandamany N, Ni Shuibhne N, et al. Neonatal brachial plexus injury: comparison of incidence and antecedents between 2 decades. Am J Obstet Gynecol 2011;204:324.e1-6.
12. Mollberg M, Hagberg H, Bager B, et al. High birthweight and shoulder dystocia: the strongest risk factors for obstetrical brachial plexus palsy in a Swedish population-based study. Acta Obstet Gynecol Scand 2005;84:654-9.
13. Inglis SR, Feier N, Chetiyaar JB, et al. Effects of shoulder dystocia training on the incidence of brachial plexus injury Am J Obstet Gynecol 2011;204:322.e1-6.
14. Hervey-Jumper SL, Justice D, Vanaman MM, et al. Torticollis associated with neonatal brachial plexus palsy. Pediatr Neurol 2011;45:305-10.
15. Hale HB, Bae DS, Waters PM. Current concepts in the management of brachial plexus birth palsy. J Hand Surg Am 2010;35:322-31.
16. Doi K. Obstetric and taumatic pediatric palsy, Peimer CA (ed). Surgery of the Hand and Upper Extremity. New York, McGraw-Hill, 1996.2.1443-63.
17. Hardy AE. Birth injuries of the brachial plexus: incidence and prognosis. J Bone Joint Surg Br 1981;63:98-101.
18. Smith NC, Rowan P, Benson LJ, et al. Neonatal brachial plexus palsy. Outcome of absent biceps function at three months of age. J Bone Joint Surg Am 2004;86:2163-70.
19. Sebastin SJ, Chung KC. Pathogenesis and management of deformities of the elbow, wrist, and hand in late neonatal brachial plexus palsy. J Pediatr Rehabil Med 2011;4:119-30.