Factors associated with neonatal brachial palsy in shoulder dystocia: a longitudinal study

Abstract

Objectives: The main goal is to analyze factors related to brachial plexus injury (BPI) after shoulder dystocia (SD). Material and methods: Longitudinal prospective analysis of SD arose in a tertiary hospital from 1/1st/ 2019 to 12/31st/ /2020. A multivariable logistic regression for BPI after SD and a survival analysis for BPI recovery after SD were performed. Results: In this period 13,414 deliveries were attended, 10,676 of those were vaginal deliveries (79.6%) reporting 69 cases of SD, with an incidence of 0.65%. SD required 102.1 seconds (SD) 10.8) as an average for solving it. Internal maneuvers were needed in 42.0% of SD reported. Neonatal BPI was suspected in 23 newborns (33.3%) at birth. Neonatal BPI at 48 hours of life was statistically associated with maternal BMI above 30 kg/m2 (OR = 7.91; CI 95% 1.3–47.7; p = 0.024), > 120 seconds for solving SD (OR = 14.4; CI 95% 1.7–121.82; p = 0.014) and operative delivery (OR = 6.8; CI 95% 1.2–37.6; p = 0.028). The BPI recovery was statistically associated with clavicle fracture (HR = 0.31 CI 95% 0.10–0.96 p = 0.042) and specific rehabilitation treatment (HR = 9.2 CI 95% 1.87–45.23 p = 0.006). Conclusions: The following factors were associated with neonatal BPI at 48 hours of life: maternal BMI above 30 kg/m2, operative delivery, or shoulder dystocia that requires more than 120 seconds for solving it. The BPI recovery was associated with clavicle fracture and specific rehabilitation treatment.