Epidemiology and surgical management of obstetric brachial plexus injury: a national cohort study.

Abstract

Objective: Obstetric brachial plexus injury (OBPI) is a serious and complex nerve injury in newborns. To date, large-scale studies and guidelines for managing OBPI are scarce, and there are major regional differences in its epidemiology and clinical management. The authors of this national cohort study aimed to report on OBPI's current epidemiology and surgical management strategies in Germany.

Methods: Patients hospitalized in Germany between January 1, 2005, and December 31, 2018, with OBPI as their primary diagnosis were identified using the ICD-10 codes P14.0 (Erb palsy), P14.1 (Klumpke palsy), and P14.3 (other brachial plexus birth injuries). Operation and Procedure Classification System codes were used to allow analysis of surgical management.

Results: A total of 2069 patients with OBPI who had been hospitalized within their 1st year of life were included in the study. Erb palsy was the most frequent OBPI subtype (66.60%). The total number of live births increased significantly from 685,795 in 2005 to 787,523 in 2018 (p < 0.001), resulting in an overall OBPI rate of 0.21 per 1000 births over the years. The incidence of OBPI per 1000 live births significantly decreased by 47.57%, from 0.28 in 2005 to 0.15 in 2018 (p < 0.001), representing a mean annual decrease of 0.010 ± 0.026. Subgroup analysis also showed a significant (p < 0.001) decrease in all three OBPI subtypes (ICD-10 codes P14.0, P14.1, and P14.3). Simultaneously, the rates of cesarean delivery significantly varied, ranging from 26.73% to 28.08% from 2005 to 2018 (p < 0.001). The most frequent risk factor for OBPI was being large for gestational age (13.83%), followed by instrumental delivery or cephalohematoma (6.30%). Total rates of surgical management ranged from 1.86% to 41.11% and had an increasing proportional trend over time (p = 0.002). Subanalysis of the different surgical treatment modalities demonstrated an increasing trend in surgical explorations and neurolyses (p = 0.001). Length of hospital stay among patients treated for OBPI remained relatively constant throughout the study period with a mean range of 3.57-4.93 days, indicating no significant change (p = 0.52).

Conclusions: OBPI is a rare disease, with a decreasing incidence paralleled by an increase in cesarean birth delivery rates between 2005 and 2018 in Germany. Total surgical management rates rose with a significant trend toward increasing microsurgical explorations and neurolyses. Being large for gestational age was identified as the main infantile risk factor for OBPI.