民族背景作为导致永久性臂丛神经出生损伤的一个风险因素：一项基于人群的研究。

Ethnic background as a risk factor for permanent brachial plexus birth injury: A population-based study.

机构信息

Department of Pediatric Orthopedics and Traumatology, New Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.

Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland.

出版信息

Acta Obstet Gynecol Scand. 2024 Jun;103(6):1201-1209. doi: 10.1111/aogs.14817. Epub 2024 Mar 12.

DOI:10.1111/aogs.14817

PMID:38470173

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11103133/

Abstract

INTRODUCTION

Brachial plexus birth injury is the most common birth injury causing permanent disability in Finland. This study aimed to assess risk factors of a permanent brachial plexus birth injury and calculate the incidence.

MATERIAL AND METHODS

This is a retrospective population-based study including all deliveries between 2006 and 2022 in Southern Finland. The number of children born, obstetric data, and migrant status were gathered from the registries of the Finnish Institute for Health and Welfare, and Statistics Finland. Race of the mothers of children with a permanent brachial plexus birth injury was recorded. The severity of permanent brachial plexus birth injury was assessed using the 3-month Toronto test score. A lower score was indicative of a more severe injury (scored 0-10).

RESULTS

One hundred of the 298 428 children born during the 17-year study period sustained a permanent brachial plexus birth injury (0.34 per 1000). Mothers of children with a permanent brachial plexus birth injury had a higher body mass index (29 vs. 24 kg/m) and their pregnancies were more often complicated by diabetes (28% vs. 12%), shoulder dystocia (58% vs. 0.3%), and/or assisted deliveries (45% vs. 10%) compared with all other mothers (p < 0.001). Thirty two of the 52 725 children born to migrant mothers had a permanent brachial plexus birth injury (0.61 per 1000). The incidence of permanent brachial plexus birth injury was 5.7 times higher among children of Black migrants from Africa (18/11 738, 1.53 per 1000) compared with children of native mothers (0.27 per 1000). Black mothers had a higher body mass index at the start of pregnancy (29 vs. 26 kg/m, p = 0.02) compared with Caucasians. Children of Black mothers had a more severe injury compared with all others (p = 0.007) with a mean 3-month Toronto test score of 4.2 (range 0.0-6.5, SD ±1.6) vs. 5.6 (range 0.0-9.3, SD ±2.2).

CONCLUSIONS

Shoulder dystocia and assisted delivery are the most important risk factors for a permanent brachial plexus birth injury. Black race was associated with a higher rate and a more severe permanent brachial plexus birth injury.

摘要

引言

臂丛神经产伤是芬兰导致永久性残疾的最常见分娩损伤。本研究旨在评估永久性臂丛神经产伤的危险因素，并计算其发生率。

材料和方法

这是一项回顾性基于人群的研究，纳入了 2006 年至 2022 年期间在芬兰南部所有分娩的婴儿。儿童出生人数、产科数据和移民身份均来自芬兰卫生与福利研究所和芬兰统计局的登记处。记录了患有永久性臂丛神经产伤的儿童的母亲的种族。使用 3 个月的多伦多测试评分评估永久性臂丛神经产伤的严重程度。较低的分数表示更严重的损伤（评分为 0-10）。

结果

在 17 年的研究期间，298428 名出生的婴儿中有 100 名患有永久性臂丛神经产伤（每 1000 名中有 0.34 名）。患有永久性臂丛神经产伤的儿童的母亲体重指数更高（29 与 24kg/m），且其妊娠更常伴有糖尿病（28%与 12%）、肩难产（58%与 0.3%）和/或辅助分娩（45%与 10%），与其他所有母亲相比（p<0.001）。52725 名移民母亲所生的婴儿中有 32 名患有永久性臂丛神经产伤（每 1000 名中有 0.61 名）。非洲黑人移民的儿童中永久性臂丛神经产伤的发生率是本土母亲儿童的 5.7 倍（18/11738，每 1000 名中有 1.53 名）。与白种人相比，黑人母亲在妊娠开始时的体重指数更高（29 与 26kg/m，p=0.02）。与所有其他人群相比，黑人母亲所生的儿童损伤更为严重（p=0.007），平均 3 个月多伦多测试评分为 4.2（范围 0.0-6.5，标准差±1.6），而所有其他人群的评分为 5.6（范围 0.0-9.3，标准差±2.2）。