Epidemiology of Neonatal Brachial Plexus Palsy in the United States: Years 1997, 2000, 2003

1
Epidemiology of Neonatal Brachial Plexus Palsy in
the United States Years 1997, 2000, 2003

• CT Mehlman, DO, MPH,
• SL Foad, MPH, J Ying, PhD
• Cincinnati, Ohio
• USA

2
PURPOSE

• To utilize a large national pediatric database to
  determine the nationwide incidence of neonatal
  brachial plexus palsy and identify significant
  risk factors.

3
METHODS

• The nationwide Kids Inpatient Database (KID) was
  utilized
• KID was developed as part of the Health Care
  Utilization Project (HCUP)
• The KID is a sample of pediatric (birth -20 years
  old) discharges from all community,
  non-rehabilitation hospitals in participating
  states
• ICD-9 codes were utilized to identify neonates
  with NBPP and risk factors for NBPP

4
METHODS

• Univariate Analysis
• Multivariate Logistic Regression
• SAS-callable SUDDAN version 9.0.1 (Research
  Triangle Institute)

5
RESULTSIncidence of NBPP in USA
Plt0.01
6
RESULTS

• Rate of instrumented delivery, breech delivery,
  shoulder dystocia, and exceptionally large baby
  (gt 4.5 kg) ?1997 to 2003 (plt0.01)
• Rate of cesarean delivery, heavy for date, and
  twin/multi born ? 1997 to 2003 (plt0.01)

7
RESULTS Adjusted Odds Ratio
8
CONCLUSIONS

• US incidence of NBPP
• 1.5 per 1000 live births
• Significant ? 1997 to 2003

9
CONCLUSIONS

• Risk Factors that confer HIGHER RISK
• Shoulder Dystocia chances of NBPP are 100 X
  higher
• Exceptionally Large Baby (gt4.5 kg) chances of
  NBPP are 14 X higher
• Instrumented Delivery chances of NBPP are 8 X
  higher

10
CONCLUSIONS

• Risk Factors that confer LOWER RISK
• C-section chances of NBPP are 8 X lower
• Twin / Multi Born chances of NBPP are 4 X lower