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Aim: To demonstrate the trajectory of long‐term recovery of upper‐extremity movement and determine optimal timing of evaluation at multidisciplinary specialty centers in children with neonatal brachial plexus palsy (NBPP). Method: All children with conservatively managed NBPP seen at one institution from 2005 to 2020 were considered for inclusion. The cohort was divided according to age at formal evaluation (≤30 or > 30 days). Active range of motion (AROM) for shoulder and elbow movements collected at each appointment were compared in local age windows between early and late cohorts. Locally estimated scatterplot smoothing was used to demonstrate the trajectory of recovery for the overall cohort. Results: More than 13 000 prospectively collected data points for 429 children (220 males, 209 females) were analysed. Elbow flexion improved to nearly full AROM for both groups over the course of the study. Shoulder abduction, forward flexion and external rotation, and forearm supination improved for the entire cohort, although greater absolute improvement, particularly at the shoulder, was seen in the early cohort (age at formal evaluation ≤30 days). AROM for elbow extension remained roughly stable for the early cohort but decreased for the late cohort (age at formal evaluation >30 days). AROM for forearm pronation decreased over time for both cohorts. Interpretation: Our data demonstrate good long‐term functional recovery for children with conservatively managed NBPP. However, early referral to multispecialty brachial plexus centers may optimize outcomes. What this paper adds: Many children with conservatively managed neonatal brachial plexus palsy have good long‐term shoulder and elbow outcomes.Early referral to multidisciplinary clinics may maximize long‐term shoulder and elbow recovery and optimize outcomes. [ABSTRACT FROM AUTHOR]

Background: Neonatal brachial plexus palsy (NBPP) results in muscle weakness and impaired somatosensory function of the arm. Current functional assessment is primarily based on clinician‐elicited measurements including muscle strength and range of motion. To what extent these measures are representative of real‐world arm movement is unclear. Objective: To determine the feasibility of using body‐worn accelerometers to remotely assess arm movements in children with NBPP. Design Prospective criterion validity study of accelerometry versus clinician assessment. Setting: Academic medical center. Participants: Nine adolescents with NBPP and nine age‐ and gender‐matched control adolescents participated in the study. All were enrolled in school and participated in community activities. Interventions: Not applicable. Methods: Standard clinician‐elicited measurements were collected. For assessing spontaneous arm movements, participants wore activity monitors during all waking hours for 7 days. Results were expressed as ratios of affected to unaffected arm motion for duration and magnitude and correlated with traditional clinic‐based assessments. Spearman correlations were used to determine relationships between accelerometry results and traditional assessments. A p value <.05 was considered statistically significant. Main Outcome Measurements Accelerometry measurements of arm motion and traditional clinical assessments. Results: Compared to control ratios, duration of arm movement and magnitude ratios were reduced in the NBPP group, particularly for arm magnitude due to reduced affected arm movement and an increase in unaffected arm movement. Ratios were highly correlated with shoulder function and, to a lesser extent, with elbow function. Conclusion: Real‐world arm use is an appropriate outcome measure that reflects functional recovery. This study demonstrates the feasibility of wearable technology to quantify duration and intensity of spontaneous arm movement in children with NBPP. Accelerometry also allows for the association between traditional clinician‐elicited assessment measures and spontaneous arm movements, demonstrating the importance of the shoulder as a focus of treatment in NBPP. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: To compare the birth injury outcomes and hospital length of stay and costs among newborns delivered at 34–42 weeks with neonatal brachial plexus palsy (NBPP) versus those without. Study design: We conducted a retrospective, cross-sectional study using data from the National Inpatient Sample to identify all newborns hospitalizations that occurred in the U.S. between 2016 and 2017. We included non-anomalous single liveborn delivered in-hospital at 34–42 weeks. The newborns with NBPP were identified by International Classification of Diseases, 10th Revision, Clinical Modification codes. Birth injury outcomes, and hospital length of stay and hospital costs were examined. A multivariable Poisson regression model with robust error variance was used to examine the association between NBPP and birth injury outcomes. A multivariable generalized linear regression model was used to examine the association between NBPP and hospital length of stay and hospital costs. Results: Of 7,019,722 non-anomalous single liveborn delivered at 34–42 weeks in the U.S. from 2016 to 2017, the rate of NBPP (n = 6695) was 0.95 per 1000 newborn hospitalizations. After multivariable regression adjustment, compared to newborns without NBPP, the risk of the composite birth injury outcome was 2.91 (95% CI 2.61–3.25) times higher in those with NBPP. Similar results of an increased risk among newborns with NBPP were observed in all individual birth injury outcomes. Compared to newborns without NBPP, after adjustment, the hospital length of stay was 1.48 (95% IC 1.38–1.59) times higher and the hospital costs were 2.21 (95% CI 1.97–2.48) times higher in those with NBPP. Conclusions: Among newborns delivered at 34–42 weeks, the risk of associated birth injuries, hospital length of stay and costs, were significantly higher in newborns with NBPP than those without. [ABSTRACT FROM AUTHOR]