A multistate population-based analysis of linked maternal and neonatal discharge records to identify risk factors for neonatal brachial plexus injury

Michael D. Freeman*, Shaun M. Goodyear, Wendy M. Leith

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

9 Citations (Web of Science)

Abstract

Objective: To evaluate the interaction and contribution of maternal and fetal risk factors associated with neonatal brachial plexus injury (BPI).

Methods: In a case-control study, matched maternal and neonatal discharge records were accessed from US State Inpatient Databases for New Jersey (2010-2012), Michigan (2010-2011), and Hawaii (2010-2011). Univariate and multivariate logistic regressions were used to evaluate associations between risk factors and BPI. Area under the receiver operating characteristic curve was used to build predictive models, including two stratified models evaluating deliveries among obese and diabetic cohorts.

Results: Among 376 325 deliveries, BPI was diagnosed in 274 (0.1%). Significant BPI risk factors included maternal obesity (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.7-4.4), maternal diabetes (OR 4.6, 95% CI 3.0-7.0), use of forceps (OR 4.6, 95% CI 2.3-9.0), and vacuum assistance (OR 2.3, 95% CI 1.7-3.3). After adjusting for shoulder dystocia and other predictive factors, cesarean reduced the risk of BPI by 88% (OR 0.1, 95% CI 0.07-0.2). When stratified by obesity and diabetes, the ORs for BPI increased significantly for macrosomia, forceps, and vacuum assistance.

Conclusion: The analysis confirms and quantifies more precisely the impact of risk factors for neonatal BPI, and provides a reliable basis for evidence-based clinical decision-making models.

Original languageEnglish
Pages (from-to)331-336
Number of pages6
JournalInternational Journal of Gynecology & Obstetrics
Volume136
Issue number3
DOIs
Publication statusPublished - Mar 2017

Keywords

  • Cesarean delivery
  • Maternal diabetes
  • Maternal obesity
  • Neonatal brachial plexus injury
  • Shoulder dystocia
  • State Inpatient Databases
  • SHOULDER DYSTOCIA
  • VAGINAL DELIVERY
  • FETAL MACROSOMIA
  • PALSY
  • PREVALENCE
  • 2ND-STAGE
  • VACUUM
  • LABOR

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