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Incidence of neonatal sixth nerve palsy in relation to mode of delivery
1Department of Paediatrics, Queen's University, Kingston General Hospital, Ontario, Canada.
During a 10-year period on a level I neonatal service the total incidence (0.4%) and incidence by mode of delivery of neonatal lateral rectus paralysis occurring among 6886 term neonates was determined. The incidence of abducens nerve injury in this population increased progressively from 0% for deliveries by cesarean section to 0.1% for spontaneous vaginal delivery, to 2.4% for forceps delivery, and to 3.2% for vacuum extraction. This suggests that increased complexity of instrumentation during delivery is associated with an increased risk of sixth nerve palsy. A proposed mechanism for the injury to the sixth nerve is described.
During a 10-year period on a level I neonatal service the total incidence (0.4%) and incidence by mode of delivery of neonatal lateral rectus paralysis occurring among 6886 term neonates was determined. The incidence of abducens nerve injury in this population increased progressively from 0% for deliveries by cesarean section to 0.1% for spontaneous vaginal delivery, to 2.4% for forceps delivery, and to 3.2% for vacuum extraction. This suggests that increased complexity of instrumentation during delivery is associated with an increased risk of sixth nerve palsy. A proposed mechanism for the injury to the sixth nerve is described.