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Assessment of Current Epidemiology and Risk Factors Surrounding Brachial Plexus Birth Palsy
Joshua M. Abzug, MD1; Charles T. Mehlman, DO, MPH2; Jun Ying, PhD3
1Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 2Orthopaedic Surgery, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH, 3University of Cincinnati College of Medicine, Cincinnati, OH
Purpose: Brachial plexus birth palsy (BPBP) is quite common in the United States, with a reported incidence of 1.5 per 1,000 live births. However, this rate has been shown to be decreasing. With the current increasing rate of Cesarean delivery, it is unknown what the current incidence of BPBP is. Additionally, more than 50% of infants with BPBP have no known risk factors. The purpose of this study was to determine the current incidence of BPBP, assess known and unknown risk factors, and evaluate the length of stay (LOS) and costs of children with an associated BPBP injury.
Materials and Methods: Data from the 1997-2012 Kids’ Inpatient Database data sets were evaluated utilizing ICD-9 codes to identify patients with a BPBP injury and various risk factors. Additionally, patient demographics and hospital characteristics were assessed. Evaluation of LOS data and cost was also performed. Multivariate logistic regression analysis was utilized to assess the association of BPBP with its known and unknown risk factors, adjusting for sociodemographic and hospital characteristics.
Results: The incidence of BPBP has steadily decreased from 1997-2012, with an incidence of 0.9 ± 0.01 per 1,000 live births recorded in 2012. Shoulder dystocia is the number one risk factor for the development of a BPBP injury, with an Odds Ratio of 166.01. Hypotonia is a newly recognized risk factor for the development of BPBP with an Odds Ratio of 1.93. Fifty-five percent of infants with BPBP still have no known risk factors. The initial hospital LOS is approximately 20% longer for children with a BPBP injury compared to those without one and the hospital stay costs are approximately 40% higher.
Conclusion: The incidence of BPBP is decreasing over time. Shoulder dystocia continues to be the number one risk factor for sustaining a BPBP injury. The increasing incidence of cesarean delivery likely corresponds to the decreasing incidence of BPBP injury. Children with a BPBP injury have longer length of stays and hospital costs compared to children without a BPBP injury.
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