DeFrancesco Christopher J, Mahon Scott J, Desai Vineet M, Pehnke Meagan, Manske M Claire, Shah Apurva S
Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA.
Department of Orthopaedic Surgery, Shriners Hospital for Children-Northern California, Sacramento, CA.
J Pediatr Orthop. 2025 Jan 1;45(1):43-50. doi: 10.1097/BPO.0000000000002800. Epub 2024 Aug 27.
While prior research provided thorough analysis of the epidemiology of brachial plexus birth injury (BPBI) from 1997 to 2012, recent trends are unknown. The goal of this study was to update the understanding of the epidemiology and risk factors for BPBI.
Installments of the Kids' Inpatient Database (1997 to 2019) were used to estimate BPBI incidence in the United States in comparison to several independent variables over time. An interaction between cesarean (C-) section and newborn weight was explored by defining BPBI rates in a stratified manner. A logistic regression model accounting for this interaction was developed to produce odds ratios for independent factors. Lastly, the temporal relationship between BPBI rates and C-section rates was explored using linear regression.
BPBI rates were steady around 0.9 to 1.1 per 1000 live births between 2006 and 2019. C-section rates were similarly stable between 32.3% and 34.0% over this period. Stratified analysis indicated C-section delivery was protective against BPBI across newborn weight classes, but the magnitude of this protective value was highest among newborns with macrosomia. Shoulder dystocia was the strongest risk factor for BPBI in the logistic regression model [adjusted odds ratio (AOR): 56.9, P <0.001]. The AOR for a newborn with macrosomia born through C-section (AOR: 0.581, 95% CI: 0.365-0.925) was lower than that for a normal weight newborn born vaginally (AOR: 1.000, P =0.022). Medicaid insurance coverage (AOR: 1.176, 95% CI: 1.124-1.230, P <0.001), female sex (AOR: 1.238, 95% CI: 1.193-1.283, P <0.001), and non-White race (AOR: 1.295, 95% CI: 1.237-1.357, P <0.001) were independent risk factors for BPBI. Over time, the rate of BPBI correlated very strongly with the rate of C-section ( R2 =0.980).
While BPBI and C-section rates were relatively stable after 2006, BPBI incidence strongly correlated with C-section rates. This highlights the need for close surveillance of BPBI rates as efforts to lower the frequency of C-section evolve. Female, Black, and Hispanic newborns and children with Medicaid insurance experience BPBI at a higher rate, a finding which could direct future research and influence policy.
Level IV-case series.
虽然先前的研究对1997年至2012年臂丛神经产伤（BPBI）的流行病学进行了全面分析，但近期趋势尚不清楚。本研究的目的是更新对BPBI流行病学和危险因素的认识。
使用儿童住院数据库分期数据（1997年至2019年）来估计美国BPBI的发病率，并与多个随时间变化的独立变量进行比较。通过分层定义BPBI发生率，探讨剖宫产（C-）与新生儿体重之间的相互作用。建立了一个考虑这种相互作用的逻辑回归模型，以得出独立因素的比值比。最后，使用线性回归探讨BPBI发生率与剖宫产率之间的时间关系。
2006年至2019年期间，BPBI发生率稳定在每1000例活产0.9至1.1例左右。在此期间，剖宫产率同样稳定在32.3%至34.0%之间。分层分析表明，剖宫产分娩对各新生儿体重组的BPBI具有保护作用，但这种保护作用在巨大儿中最为显著。在逻辑回归模型中，肩难产是BPBI最强的危险因素[调整后比值比（AOR）：56.9，P<0.001]。经剖宫产出生的巨大儿的AOR（AOR：0.581，95%CI：0.365-0.925）低于经阴道出生的正常体重新生儿的AOR（AOR：1.000，P=0.022）。医疗补助保险覆盖（AOR：1.176，95%CI：1.124-1.230，P<0.001）、女性（AOR：1.238，95%CI：1.193-1.283，P<0.001）和非白人种族（AOR：1.295，95%CI：1.237-1.357，P<0.001）是BPBI的独立危险因素。随着时间的推移，BPBI发生率与剖宫产率密切相关（R2=0.980）。
虽然2006年后BPBI和剖宫产率相对稳定，但BPBI发生率与剖宫产率密切相关。这凸显了随着降低剖宫产频率的努力不断推进，对BPBI发生率进行密切监测的必要性。有医疗补助保险的女性、黑人、西班牙裔新生儿和儿童BPBI发生率较高，这一发现可为未来研究提供方向并影响政策。
IV级——病例系列。
