gms | German Medical Science

Objectives/Interrogation: Brachial plexus birth injury is a condition in which the brachial plexus is thought to be damaged during the birth process. Studies have cited a varying incidence rate ranging from 0.5 to 4.0/1000 live births. The purpose of this study is to evaluate birth claims data in the state of Colorado over a 15 year period to identify risk and protective factors for brachial plexus birth injury (BPBI).

Methods: A data request was made to the Colorado Hospital Association for birth claims data. We requested all birth claims from the years 2000 to 2014. ICD9 codes for variables of interest included: brachial plexus birth injury, shoulder dystocia, heavy-for-dates, macrosomia, breech delivery, instrumented birth, birth hypoxia, and gestational diabetes. Descriptive statistics and univariate analysis was performed on birth claims. A multivariable logistic regression model quantified both risk and protective factors as odds ratios (OR) with 95% confidence intervals (CI).

Results and Conclusions: There were 966,906 birth records received from state hospital association. The brachial plexus birth injury rate was 0.63/1000 live births averaged over all years. The mean birthweight was 3187 grams for the total population and 3807 grams for the BPBI births. Each year after the year 2000 reduced the chance of BPBI by 4% (OR 0.96, 95%CI: 0.94, 0.97, p<0.001). Asian, black, or Hispanic were more likely to have a BPBI than white births. Births impacted by shoulder dystocia (OR 49.77, 95%CI: 39.23, 62.77, p<0.001), instrumented forceps births (OR 21.29, 95%CI: 11.90, 35.47, p<0.001), breech delivery (OR 17.75, 95%CI: 5.73, 42.33, p<0.001), and gestational diabetes (OR 5.69, 95%CI: 4.16, 7.66, p<0.001) were at higher risk of BPBI. Cesarean Delivery (OR 0.27, 95%CI: 0.20, 0.36, p<0.001) was protective of BPBI but multiple gestation (OR, 4.86 (95%CI: 2.55, 8.43, p<0.001) was not. Colorado births experienced a decreased risk of BPBI from 0.82/1000 live births in 2000 vs. the US rate of 1.6/1000 (p<0.001) to 0.56/1000 in 2012 vs. the US rate of 0.9/1000 (p=0.003).

Brachial plexus birth injury rate decreased between 2000 and 2014. Historically Colorado has had a lower BPBI rate than the United States. Shoulder dystocia, instrumented forceps birth, gestational diabetes, and breech delivery are significant predictors for BPBI. Increased awareness of shoulder dystocia and instrumented birth have been hypothesized to have reduced these rates. Non-white patients also appear to be at higher risk for BPBI.