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The Association of Hospital Characteristics with Brachial Plexus Birth Injury

Mary Claire Manske1, Barton Wise2, Yueju Li2

  • 1CHILDREN'S HOSPITAL OF PHILADELPHIA.

Research Square
|April 3, 2026
PubMed

Insights

Hospital characteristics like lower obstetric care levels and higher proportions of Black births are linked to increased brachial plexus birth injury (BPBI) risk. These associations remained consistent across racial groups.

Area of Science:

  • Obstetrics and Gynecology
  • Pediatric Surgery
  • Health Services Research

Background:

  • Brachial plexus birth injury (BPBI) is a significant concern in obstetrics.
  • Understanding factors contributing to BPBI is crucial for prevention and improved outcomes.
  • Racial disparities in healthcare necessitate examining associations within diverse patient populations.

Purpose of the Study:

  • To evaluate the association between hospital characteristics and the incidence of brachial plexus birth injury (BPBI).
  • To determine if these associations differ based on the race of the infant.
  • To identify specific hospital-level factors that may increase BPBI risk.

Main Methods:

  • Retrospective analysis of liveborn infants from 1997-2019 using the Kids' Inpatient Database.
  • Data linkage with the American Hospital Association Annual Survey for hospital characteristics.
  • Multivariable logistic regression models and interaction terms to assess adjusted associations and effect modification by race.

Main Results:

  • Analysis included 7,824,862 sampled infants, representing over 25 million births.
  • Lower obstetric care level, hospital complications, and hospitals in the highest quartile of Black births were associated with increased BPBI risk.
  • Associations between hospital characteristics and BPBI were consistent across all racial groups.

Conclusions:

  • Hospital characteristics related to resources, quality, and patient demographics are associated with BPBI.
  • Higher proportions of Black infants in a hospital were linked to greater BPBI odds, even after adjusting for individual factors.
  • This suggests potential unmeasured structural differences in obstetric care delivery impacting BPBI risk.
Abstract

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