Wilson Thomas J, Chang Kate W C, Chauhan Suneet P, Yang Lynda J S
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and.
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center, Houston, Texas.
J Neurosurg Pediatr. 2016 May;17(5):618-24. doi: 10.3171/2015.10.PEDS15543. Epub 2016 Jan 22.
OBJECTIVE Neonatal brachial plexus palsy (NBPP) occurs due to the stretching of the nerves of the brachial plexus before, during, or after delivery. NBPP can resolve spontaneously or become persistent. To determine if nerve surgery is indicated, predicting recovery is necessary but difficult. Historical attempts explored the association of recovery with only clinical and electrodiagnostic examinations. However, no data exist regarding the neonatal and peripartum factors associated with NBPP persistence. METHODS This retrospective cohort study involved all NBPP patients at the University of Michigan between 2005 and 2015. Peripartum and neonatal factors were assessed for their association with persistent NBPP at 1 year, as defined as the presence of musculoskeletal contractures or an active range of motion that deviated from normal by > 10° (shoulder, elbow, hand, and finger ranges of motion were recorded). Standard statistical methods were used. RESULTS Of 382 children with NBPP, 85% had persistent NBPP at 1 year. A wide range of neonatal and peripartum factors was explored. We found that cephalic presentation, induction or augmentation of labor, birth weight > 9 lbs, and the presence of Horner syndrome all significantly increased the odds of persistence at 1 year, while cesarean delivery and Narakas Grade I to II injury significantly reduced the odds of persistence. CONCLUSIONS Peripartum/neonatal factors were identified that significantly altered the odds of having persistent NBPP at 1 year. Combining these peripartum/neonatal factors with previously published clinical examination findings associated with persistence should allow the development of a prediction algorithm. The implementation of this algorithm may allow the earlier recognition of those cases likely to persist and thus enable earlier intervention, which may improve surgical outcomes.
目的 新生儿臂丛神经麻痹（NBPP）是由于分娩前、分娩期间或分娩后臂丛神经受到牵拉所致。NBPP可自发恢复或持续存在。为了确定是否需要进行神经手术，预测恢复情况很有必要，但也很困难。以往的研究仅探讨了恢复与临床及电诊断检查之间的关联。然而，目前尚无关于与NBPP持续存在相关的新生儿及围产期因素的数据。方法 这项回顾性队列研究纳入了2005年至2015年间密歇根大学的所有NBPP患者。评估围产期和新生儿因素与1岁时持续性NBPP的关联，持续性NBPP定义为存在肌肉骨骼挛缩或主动活动范围偏离正常>10°（记录了肩部、肘部、手部和手指的活动范围）。采用标准统计方法。结果 在382例NBPP患儿中，85%在1岁时患有持续性NBPP。研究了广泛的新生儿和围产期因素。我们发现头先露、引产或催产、出生体重>9磅以及存在霍纳综合征均显著增加了1岁时持续性NBPP的几率，而剖宫产和纳拉卡斯I至II级损伤则显著降低了持续性NBPP的几率。结论 确定了围产期/新生儿因素，这些因素显著改变了1岁时患有持续性NBPP的几率。将这些围产期/新生儿因素与先前发表的与持续性相关的临床检查结果相结合，应该能够开发出一种预测算法。该算法的实施可能有助于更早地识别那些可能持续存在的病例，从而实现更早的干预，这可能会改善手术效果。
