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Risk factors for neonatal brachial plexus palsy: a systematic review and meta‐analysis
Author(s) -
Van der Looven Ruth,
Le Roy Laura,
Tanghe Emma,
Samijn Bieke,
Roets Ellen,
Pauwels Nele,
Deschepper Ellen,
De Muynck Martine,
Vingerhoets Guy,
Van den Broeck Christine
Publication year - 2020
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.14381
Subject(s) - medicine , shoulder dystocia , odds ratio , meta analysis , obstetrics , gestational diabetes , confidence interval , caesarean section , incidence (geometry) , brachial plexus , fetal macrosomia , pregnancy , pediatrics , gestation , surgery , genetics , physics , optics , biology
Aim To provide a comprehensive update on the most prevalent, significant risk factors for neonatal brachial plexus palsy (NBPP). Method Cochrane CENTRAL, MEDLINE, Web of Science, Embase, and ClinicalTrials.gov were searched for relevant publications up to March 2019. Studies assessing risk factors of NBPP in relation to typically developing comparison individuals were included. Meta‐analysis was performed for the five most significant risk factors, on the basis of the PRISMA statement and MOOSE guidelines. Pooled odds ratios (ORs), 95% confidence intervals (CIs), and across‐study heterogeneity ( I 2 ) were reported. Reporting bias and quality of evidence was rated. In addition, we assessed the incidence of NBPP. Results Twenty‐two observational studies with a total sample size of 29 419 037 live births were selected. Significant risk factors included shoulder dystocia (OR 115.27; 95% CI 81.35–163.35; I 2 =92%), macrosomia (OR 9.75; 95% CI 8.29–11.46; I 2 =70%), (gestational) diabetes (OR 5.33; 95% CI 3.77–7.55; I 2 =59%), instrumental delivery (OR 3.8; 95% CI 2.77–5.23; I 2 =77%), and breech delivery (OR 2.49; 95% CI 1.67–3.7; I 2 =70%). Caesarean section appeared as a protective factor (OR 0.13; 95% CI 0.11–0.16; I 2 =41%). The pooled overall incidence of NBPP was 1.74 per 1000 live births. It has decreased in recent years. Interpretation The incidence of NBPP is decreasing. Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are risk factors for NBPP. Caesarean section appears as a protective factor. What this paper adds The overall incidence of neonatal brachial plexus palsy is 1.74 per 1000 live births. The incidence has declined significantly. Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are the main risk factors. Prevention is difficult owing to unpredictability and often labour‐related risk.