Predictors of neonatal brachial plexus palsy subsequent to resolution of shoulder dystocia

Objective: The objective was to ascertain factors among deliveries complicated by shoulder dystocia (SD) and neonatal brachial plexus palsy (NBPP). Methods: At 11 hospitals, deliveries complicated by SD were identified. The inclusion criteria were vaginal delivery of non-anomalous, singleton at 34–42 weeks. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated. Receiver operating characteristic (ROC) curves were created to evaluate the predictive value of the models for NBPP. Results: Of the 62,939 individuals who delivered vaginally, 1,134 (1.8%) had SD and met other inclusion criteria. Among the analytic cohort, 74 (6.5%) had NBPP. The factor known before delivery which was associated with NBPP was diabetes (aOR = 3.87; 95% CI = 2.13–7.01). After delivery, the three factors associated with NBPP were: (1) birthweight of at least 4000 g (aOR = 1.83; 95% CI = 1.05–3.20); (2) calling for help during the SD (aOR = 4.09, 95% CI = 2.29–7.30), and (3) the duration of SD ≥120 sec (aOR = 2.47, 95% CI = 1.30–4.69). The AUC under the ROC curve for these independent factors was 0.79 (95% CI = 0.77 − 0.82). Conclusions: Few factors were identified that were associated with NBPP after SD, but they could not reliably predict which neonates will experience the complication.