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Neurological recovery in obstetric brachial plexus injuries: an historical cohort study
Agnes F Hoeksma1, Anne Marie ter Steeg, Rob G H H Nelissen
1Department of Rehabilitation Medicine, Academic Medical Centre, Amsterdam. a.f.hoeksma@worldonline.nl
Insights
Complete neurological recovery from obstetric brachial plexus injury (OBPI) occurred in 66% of children, with delayed recovery noted in half. External rotation and supination were the slowest to recover.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Developmental Pediatrics
Background:
- Obstetric brachial plexus injury (OBPI) is a significant concern affecting newborns.
- Understanding neurological recovery patterns and prognostic factors is crucial for effective management.
Purpose of the Study:
- To investigate the rate and extent of neurological recovery in children with OBPI.
- To identify prognostic factors influencing neurological recovery in OBPI.
- To evaluate functional outcomes in a cohort of children with OBPI.
Main Methods:
- Historical cohort study design.
- Inclusion of 56 children diagnosed with OBPI from birth to 7 years.
- Standardized neurological examinations at fixed intervals by a single examiner.
Main Results:
- Complete neurological recovery was observed in 66% (37/56) of children.
- Delayed recovery (1.5-16 months) occurred in 50% of those with complete recovery.
- External rotation and supination showed the slowest and least recovery.
- External rotation and supination strength at follow-up were better predictors of complete recovery than biceps function at three months.
Conclusions:
- Neurological recovery in OBPI may be less favorable than commonly reported, with a significant proportion experiencing delayed recovery.
- Specific muscle group recovery (external rotation, supination) is a key indicator for predicting eventual complete neurological recovery.
- Initial postpartum symptoms are not reliable prognostic indicators for OBPI recovery.
Abstract:
An historical cohort study was conducted to investigate the rate and extent of neurological recovery in obstetric brachial plexus injury (OBPI) and to identify possible prognostic factors in a cohort of children with OBPI from birth to 7 years. All children (n=56; 31 females, 25 males) with OBPI were evaluated at fixed time intervals by one examiner. They underwent a final neurological examination at a mean age of 3 years 10 months (range 1 to 7 years). Neurological outcome was not as favourable as is often reported: complete neurological recovery occurred in 37 out of 56 children (66%). In half of these there was delayed recovery, in which case complete neurological recovery was assessed from 1.5 to 16 months of age (median age 6.5 months, SD 4.2 months). External rotation and supination were the last to recover and recovered the least. Although biceps function at three months was considered to be the best indicator for operative treatment, external rotation and supination were found to be better in predicting eventual complete recovery. Initial symptoms directly post partum were not found to be prognostic. Functional outcome was mainly reported to be good.
