Incidence and Prognosis of Neonatal Brachial Plexus Palsy With and Without Clavicle Fractures

Wall, Lindley B. MD; Mills, Janith K. MPAS; Leveno, Kenneth MD; Jackson, Gregory MD; Wheeler, Lesley C. BA; Oishi, Scott N. MD; Ezaki, Marybeth MD

doi: 10.1097/AOG.0000000000000207
Contents: Original Research

OBJECTIVE: To report the incidence of neonatal brachial plexus palsy with and without ipsilateral clavicle fracture in a population of newborns and to compare the prognosis between these subgroups.

METHODS: This was a retrospective review of 3,739 clavicle fractures and 1,291 brachial plexus palsies in neonates over a 24-year period from a geographically defined health care system with reference to county-wide population data.

RESULTS: A referral clinic for children with brachial plexus palsies evaluated 1,383 neonates, of whom 320 also had ipsilateral clavicular fracture. As a result of referral patterns within the region, it is likely that this represents nearly all infants from the area with persistent brachial plexus injury after 2 months of age. Among the children evaluated without concomitant clavicular fracture, 72% resolved spontaneously (154/214); among those with concomitant clavicular fracture, 74% healed spontaneously (55/74). Limiting the analysis to neonates delivered at Parkland Memorial Hospital and assuming that those neonates with a discharge diagnosis of brachial plexus injury with or without clavicular fracture who did not present to the referral brachial plexus injury clinic had complete resolution, 94.4% without clavicular fracture resolved and 98.1% with clavicular fracture resolved (P=.005).

CONCLUSIONS: The risk of persistent neurologic deficit from a birth-related brachial plexus palsy is lower than what has been reported, and the presence of a clavicle fracture may improve the likelihood of recovery.

LEVEL OF EVIDENCE: III

The occurrence of an ipsilateral clavicle fracture may improve the prognosis for recovery of a neonatal brachial plexus palsy.

Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri; and the Texas Scottish Rite Hospital for Children, and the Departments of Obstetrics & Gynecology and Pediatrics, University of Texas Southwestern Medical School, Dallas, Texas.

Corresponding author: Marybeth Ezaki, MD, Texas Scottish Rite Hospital for Children, 2222 Welborn Street 2C, Dallas, TX 75219; e-mail: Marybeth.Ezaki@tsrh.org.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists.