TY - JOUR
T1 - A multistate population-based analysis of linked maternal and neonatal discharge records to identify risk factors for neonatal brachial plexus injury
AU - Freeman, Michael D.
AU - Goodyear, Shaun M.
AU - Leith, Wendy M.
N1 - Publisher Copyright:
© 2016 International Federation of Gynecology and Obstetrics
PY - 2017/3
Y1 - 2017/3
N2 - Objective: To evaluate the interaction and contribution of maternal and fetal risk factors associated with neonatal brachial plexus injury (BPI). Methods: In a case–control study, matched maternal and neonatal discharge records were accessed from US State Inpatient Databases for New Jersey (2010–2012), Michigan (2010–2011), and Hawaii (2010–2011). Univariate and multivariate logistic regressions were used to evaluate associations between risk factors and BPI. Area under the receiver operating characteristic curve was used to build predictive models, including two stratified models evaluating deliveries among obese and diabetic cohorts. Results: Among 376 325 deliveries, BPI was diagnosed in 274 (0.1%). Significant BPI risk factors included maternal obesity (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.7–4.4), maternal diabetes (OR 4.6, 95% CI 3.0–7.0), use of forceps (OR 4.6, 95% CI 2.3–9.0), and vacuum assistance (OR 2.3, 95% CI 1.7–3.3). After adjusting for shoulder dystocia and other predictive factors, cesarean reduced the risk of BPI by 88% (OR 0.1, 95% CI 0.07–0.2). When stratified by obesity and diabetes, the ORs for BPI increased significantly for macrosomia, forceps, and vacuum assistance. Conclusion: The analysis confirms and quantifies more precisely the impact of risk factors for neonatal BPI, and provides a reliable basis for evidence-based clinical decision-making models.
AB - Objective: To evaluate the interaction and contribution of maternal and fetal risk factors associated with neonatal brachial plexus injury (BPI). Methods: In a case–control study, matched maternal and neonatal discharge records were accessed from US State Inpatient Databases for New Jersey (2010–2012), Michigan (2010–2011), and Hawaii (2010–2011). Univariate and multivariate logistic regressions were used to evaluate associations between risk factors and BPI. Area under the receiver operating characteristic curve was used to build predictive models, including two stratified models evaluating deliveries among obese and diabetic cohorts. Results: Among 376 325 deliveries, BPI was diagnosed in 274 (0.1%). Significant BPI risk factors included maternal obesity (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.7–4.4), maternal diabetes (OR 4.6, 95% CI 3.0–7.0), use of forceps (OR 4.6, 95% CI 2.3–9.0), and vacuum assistance (OR 2.3, 95% CI 1.7–3.3). After adjusting for shoulder dystocia and other predictive factors, cesarean reduced the risk of BPI by 88% (OR 0.1, 95% CI 0.07–0.2). When stratified by obesity and diabetes, the ORs for BPI increased significantly for macrosomia, forceps, and vacuum assistance. Conclusion: The analysis confirms and quantifies more precisely the impact of risk factors for neonatal BPI, and provides a reliable basis for evidence-based clinical decision-making models.
KW - Cesarean delivery
KW - Maternal diabetes
KW - Maternal obesity
KW - Neonatal brachial plexus injury
KW - Shoulder dystocia, State Inpatient Databases
UR - http://www.scopus.com/inward/record.url?scp=85020374457&partnerID=8YFLogxK
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U2 - 10.1002/ijgo.12059
DO - 10.1002/ijgo.12059
M3 - Article
C2 - 28099684
AN - SCOPUS:85020374457
SN - 0020-7292
VL - 136
SP - 331
EP - 336
JO - International Journal of Gynecology and Obstetrics
JF - International Journal of Gynecology and Obstetrics
IS - 3
ER -