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A multistate population‐based analysis of linked maternal and neonatal discharge records to identify risk factors for neonatal brachial plexus injury
Author(s) -
Freeman Michael D.,
Goodyear Shaun M.,
Leith Wendy M.
Publication year - 2017
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12059
Subject(s) - medicine , brachial plexus injury , odds ratio , confidence interval , population , obstetrics , univariate analysis , logistic regression , receiver operating characteristic , fetal macrosomia , advanced maternal age , brachial plexus , multivariate analysis , pregnancy , gestational diabetes , surgery , fetus , environmental health , gestation , biology , genetics
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 OR s 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.