Upper LimbRisk factors associated with neonatal brachial plexus palsy in the United StatesVakhshori, Venusa; Bouz, Gabriel J.a; Alluri, Ram K.a; Stevanovic, Milana; Ghiassi, Alidada; Lightdale, NinabAuthor Information aDepartment of Orthopaedic Surgery, Keck Medical Center at the University of Southern California bDepartment of Orthopaedic Surgery, Children’s Hospital Los Angeles, Los Angeles, California, USA Correspondence to Venus Vakhshori, MD, Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, 1520 San Pablo Street, #2000, Los Angeles, CA 90033, USA, Tel: +1 818 605 3779; fax: +1 323 226 4051; e-mail: firstname.lastname@example.org Journal of Pediatric Orthopaedics B: July 2020 - Volume 29 - Issue 4 - p 392-398 doi: 10.1097/BPB.0000000000000706 Buy Metrics Abstract Neonatal brachial plexus palsy (NBPP) is a birth injury that can cause severe functional loss in the affected limb. The purpose of this study was to determine the temporal changes in the national incidence of this condition and whether associated risk factors have changed over time. Children born via vaginal delivery were identified in the Kids’ Inpatient Database (KID) from 1997 to 2012, and those with NBPP were identified. The trend in incidence and risk factors were assessed through the study period. The nationwide incidence of NBPP decreased during the study period. Infants with shoulder dystocia, fetal macrosomia, and gestational diabetes had the highest risk of developing NBPP, while multiple birth mates during delivery had a protective effect. Multiple risk factors, including shoulder dystocia, macrosomia, and heavy for dates became less predictive of the development of NBPP over time. Several risk factors predispose children to the development of NBPP, and the effect of these risk factors has been changing. This information can guide obstetric treatment to help prevent NBPP. Level of evidence is diagnostic, level 3. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.