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Development of a Neonatal Rat Model for Brachial Plexus Birth Injury
Published on: March 27, 2026
Risk and protective factors for birth-related clavicle fracture and brachial plexus birth injury: a national cohort
Sofia Voss1, Fredrik Ahlsson2, Cecilia Ekéus2
1Department of Women's and Children's Health, Institutionen for kvinnors och barns halsa, Uppsala universitet, Uppsala, Uppsala County, Sweden sofia.voss@uu.se.
Insights
Birth-related clavicle fractures and brachial plexus birth injuries (BPBI) are decreasing in Sweden. These conditions, though rare, share modifiable risk factors, highlighting the need for ongoing monitoring.
Area of Science:
- Obstetrics and Gynecology
- Pediatric Surgery
- Public Health
Background:
- Clavicle fracture is the most common birth-related fracture, while brachial plexus birth injury (BPBI) is a severe complication with potential lifelong sequelae.
- Both conditions cause parental concern and dissatisfaction, necessitating an understanding of their incidence trends.
Purpose of the Study:
- To investigate the changing incidence of reported clavicle fracture and BPBI over time in Sweden.
- To identify risk and protective factors associated with these birth injuries.
Main Methods:
- A register-based national cohort study was conducted in Sweden from 2010 to 2022, utilizing the Swedish Medical Birth Register.
- The study included all term singleton live births, comparing infants with clavicle fracture or BPBI to those without, excluding elective cesarean sections.
- Incidence rates were analyzed, and multivariable logistic regression was employed to calculate odds ratios (ORs) with 95% confidence intervals (CIs).
Main Results:
- Over 1.2 million live births were analyzed, with clavicle fracture incidence at 0.23% and BPBI at 0.13%.
- A significant decrease in incidence was observed: 72% for clavicle fracture and 44% for BPBI during the study period.
- Shoulder dystocia, macrosomia, and vacuum extraction were identified as strong risk factors, while cesarean delivery and low birth weight were protective.
Conclusions:
- Reported birth-related clavicle fractures and BPBI are rare and declining in Sweden.
- Shared maternal and obstetric risk factors, many of which are modifiable, underscore the interconnectedness of these conditions.
- Continued monitoring is crucial to adapt to evolving obstetric practices and population characteristics.
Objective:
Clavicle fracture is the most common birth-related fracture, resulting in concerns and dissatisfaction, while brachial plexus birth injury (BPBI) is a severe complication with potential lifelong sequelae. The study investigated how the incidence of reported clavicle fracture and BPBI has changed over time in Sweden.
Design:
A register-based national cohort study (2010-2022).
Setting:
The Swedish Medical Birth Register.
Patients:
All term singleton live births in Sweden with birth-related clavicle fracture or BPBI were compared to infants without these diagnoses. Elective caesarean sections were excluded.
Main Outcome Measures:
Incidence of clavicle fracture and BPBI following birth. Multivariable logistic regression was used to calculate crude and adjusted ORs with 95% CIs.
Results:
Among 1 224 709 live births 0.23% (2796 infants) were diagnosed with a clavicle fracture and 0.13% (1630 infants) with a BPBI. During the study period, a relative decrease in incidence of 72% was observed for clavicle fracture and 44% for BPBI. Strong risk factors for clavicle fracture and BPBI were shoulder dystocia (5.23 (4.34-6.31) and 49.40 (43.40-56.22), respectively), macrosomia and vacuum extraction. The breech position was associated with BPBI but not clavicle fracture. Protective factors included caesarean delivery, occiput posterior presentation and low birth weight.
Conclusion:
Reported birth-related clavicle fractures and BPBI are rare and decreasing in Sweden. The conditions share several maternal and obstetric risk factors, many of which are modifiable. Continued monitoring is important as obstetric guidelines, practices and population characteristics evolve.
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