For every 1,000 live births in the United States, there are 0.5 to 3 brachial plexus birth injuries. Almost 30% of those with brachial plexus birth injury (“BPBI”) have permanent neurological deficits or impairments. Over the course of decades, fluctuating rates of BPBI have been reported despite advances in care that would otherwise be expected to decrease the incidence of BPBI. Among babies who have sustained BPBI, only half had known risk factors.
What Is The Brachial Plexus?
According to the National Institute of Neurological Disorders and Stroke, the brachial plexus is a network of nerves that conducts signals from the spine to the shoulder, arm, and hand. Brachial plexus injuries are caused by damage to those nerves. Symptoms may include a limp or paralyzed arm; lack of muscle control in the arm, hand, or wrist; and a lack of feeling or sensation in the arm or hand. Brachial plexus injuries can occur as a result of shoulder trauma, tumors, or inflammation.
The site and type of brachial plexus injury determines the prognosis. For avulsion and rupture injuries, there is no potential for recovery unless surgical reconnection is made in a timely manner. The potential for recovery varies for neuroma and neuropraxia injuries. Most individuals with neuropraxia injuries recover spontaneously with a 90-100% return of function.
Some brachial plexus injuries may heal without treatment. Many children who are injured during birth improve or recover by 3 to 4 months of age. Treatment for brachial plexus injuries includes physical therapy and, in some cases, surgery.
Twenty percent of children with BPBI do not fully recover. A significant percentage of BPBI patients have functional limitations, bony deformities, or joint contractures. The lasting effects of BPBI may lead to lifelong musculoskeletal functional implications.
Risk Factors For Brachial Plexus Birth Injury
Risk factors for brachial plexus birth injury include gestational diabetes, fetal macrosomia, instrument-assisted delivery, prolonged labor and/or breech delivery. Babies are often born with one or more of the risk factors for brachial plexus birth injury. Increased birth weight and gestational diabetes are associated with an increased risk of BPBI when compared to babies born with a birthweight less than 3499 g.
Shoulder dystocia, macrosomia, gestational diabetes, fetal malpresentation, and excessive maternal weight gain are all risk factors for brachial plexus birth injury. While rates of macrosomia have been decreasing, rates of shoulder dystocia have been increasing.
A case control study of 52 mothers who had delivered a child with a BPBI injury and 132 mothers who had delivered without BPBI injury found that the odds of BPBI were 2.5 times higher when oxytocin was used and 3.7 times higher when tachysystole occurred. The odds of BPBI injury are increased when tachysystole and oxytocin occur during the mother’s labor.
The study concluded that when three or more of the following variables were present in any combination, a higher risk for giving birth to an infant with BPBI is created: weight gain during pregnancy, longer than 61.5 min of stage 2 labor, >26.4 years of age, tachysystole, or persistent fetal malpresentation.
If your baby suffered a brachial plexus injury during labor and delivery that may be due to medical negligence, you should promptly find a brachial plexus birth injury lawyer in your U.S. state who may investigate your brachial plexus birth injury claim for you and represent you and your baby in a brachial plexus birth injury case, if appropriate.
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