Mateusz Gładysz FESSH prep

FESSH prep Peripheral nerve injury Pooled incidence and its trend, shoulder dystocia and the protective association of caesarean delivery, recovery by Narakas group, timing of referral to a multidisciplinary centre

Brachial plexus birth injury: epidemiology, risk factors and prognosis

Last reviewed v1.0

FESSH-073Peripheral nerve injury●●○ intermediate

Regarding brachial plexus birth injury (neonatal brachial plexus palsy):

  1. 1.Population data show that the incidence of neonatal brachial plexus palsy has been rising in recent decades.

  2. 2.Caesarean delivery is associated with a higher risk of neonatal brachial plexus palsy than vaginal delivery.

  3. 3.Recent reports confirm that about 75–95% of infants with neonatal brachial plexus palsy recover completely without treatment.

  4. 4.Infants in Narakas groups I–II are much more likely than those in groups III–IV to recover biceps function by 3 months of age.

  5. 5.A clavicular fracture can cause pain-limited arm movement that mimics neonatal brachial plexus palsy.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-073
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. Population data show that the incidence of neonatal brachial plexus palsy has been rising in recent decades.

    False

    A meta-analysis of 22 observational studies (more than 29 million live births) found a pooled incidence of 1.74 per 1000 live births and a decline in recent years. A United States national database study also found a significant decrease in incidence over time.

    • Van der Looven R, Le Roy L, Tanghe E, Samijn B, Roets E, Pauwels N, et al.. Risk factors for neonatal brachial plexus palsy: a systematic review and meta-analysis. Dev Med Child Neurol. 2020;62(6):673-683. PMID 31670385
    • Foad SL, Mehlman CT, Ying J. The epidemiology of neonatal brachial plexus palsy in the United States. J Bone Joint Surg Am. 2008;90(6):1258-64. PMID 18519319

  2. 2. Caesarean delivery is associated with a higher risk of neonatal brachial plexus palsy than vaginal delivery.

    False

    In pooled analysis caesarean section was associated with a lower risk (odds ratio 0.13), whereas shoulder dystocia carried by far the highest risk, followed by macrosomia, maternal diabetes, instrumental and breech delivery. Even so, about half of affected infants (54% in a national database study) have no known risk factor.

    • Van der Looven R, Le Roy L, Tanghe E, Samijn B, Roets E, Pauwels N, et al.. Risk factors for neonatal brachial plexus palsy: a systematic review and meta-analysis. Dev Med Child Neurol. 2020;62(6):673-683. PMID 31670385
    • Foad SL, Mehlman CT, Ying J. The epidemiology of neonatal brachial plexus palsy in the United States. J Bone Joint Surg Am. 2008;90(6):1258-64. PMID 18519319

  3. 3. Recent reports confirm that about 75–95% of infants with neonatal brachial plexus palsy recover completely without treatment.

    False

    Foad and colleagues' evidence-based review notes that the often-quoted spontaneous recovery rate of 75–95% is not supported by more recent reports. Recovery depends strongly on the extent of the lesion: complete recovery at 6 months was reported in 65% of infants in Narakas groups I–II but only 14% of those in groups III–IV.

    • Foad SL, Mehlman CT, Foad MB, Lippert WC. Prognosis following neonatal brachial plexus palsy: an evidence-based review. J Child Orthop. 2009;3(6):459-63. PMID 19885693

  4. 4. Infants in Narakas groups I–II are much more likely than those in groups III–IV to recover biceps function by 3 months of age.

    True

    In the same review, 64% of infants in Narakas groups I–II recovered biceps function by 3 months, against 9% in groups III–IV — about 19 times the odds. The review rated the underlying literature as poor in quality, mostly level IV.

    • Foad SL, Mehlman CT, Foad MB, Lippert WC. Prognosis following neonatal brachial plexus palsy: an evidence-based review. J Child Orthop. 2009;3(6):459-63. PMID 19885693

  5. 5. A clavicular fracture can cause pain-limited arm movement that mimics neonatal brachial plexus palsy.

    True

    A clavicular or humeral fracture may cause painful pseudoparesis. Examination for apparent brachial plexus palsy should assess associated fracture and active/passive movement.

    • Shah V, Coroneos CJ, Ng E. The evaluation and management of neonatal brachial plexus palsy. Paediatrics & child health. 2021;26(8):493-497. PMID 34992702