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Risk factors for neonatal brachial plexus palsy: a systematic review and meta‐analysis
Aim To provide a comprehensive update on the most prevalent, significant risk factors for neonatal brachial plexus palsy (NBPP). Method Cochrane CENTRAL, MEDLINE, Web of Science, Embase, and ClinicalTrials.gov were searched for relevant publications up to March 2019. Studies assessing risk factors o...
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| Published in: | Developmental medicine and child neurology 2020-06, Vol.62 (6), p.673-683 |
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| Main Authors: | , , , , , , , , , |
| Format: | Article |
| Language: | English |
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| container_end_page | 683 |
| container_issue | 6 |
| container_start_page | 673 |
| container_title | Developmental medicine and child neurology |
| container_volume | 62 |
| creator | Van der Looven, Ruth Le Roy, Laura Tanghe, Emma Samijn, Bieke Roets, Ellen Pauwels, Nele Deschepper, Ellen De Muynck, Martine Vingerhoets, Guy Van den Broeck, Christine |
| description | Aim
To provide a comprehensive update on the most prevalent, significant risk factors for neonatal brachial plexus palsy (NBPP).
Method
Cochrane CENTRAL, MEDLINE, Web of Science, Embase, and ClinicalTrials.gov were searched for relevant publications up to March 2019. Studies assessing risk factors of NBPP in relation to typically developing comparison individuals were included. Meta‐analysis was performed for the five most significant risk factors, on the basis of the PRISMA statement and MOOSE guidelines. Pooled odds ratios (ORs), 95% confidence intervals (CIs), and across‐study heterogeneity (I2) were reported. Reporting bias and quality of evidence was rated. In addition, we assessed the incidence of NBPP.
Results
Twenty‐two observational studies with a total sample size of 29 419 037 live births were selected. Significant risk factors included shoulder dystocia (OR 115.27; 95% CI 81.35–163.35; I2=92%), macrosomia (OR 9.75; 95% CI 8.29–11.46; I2=70%), (gestational) diabetes (OR 5.33; 95% CI 3.77–7.55; I2=59%), instrumental delivery (OR 3.8; 95% CI 2.77–5.23; I2=77%), and breech delivery (OR 2.49; 95% CI 1.67–3.7; I2=70%). Caesarean section appeared as a protective factor (OR 0.13; 95% CI 0.11–0.16; I2=41%). The pooled overall incidence of NBPP was 1.74 per 1000 live births. It has decreased in recent years.
Interpretation
The incidence of NBPP is decreasing. Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are risk factors for NBPP. Caesarean section appears as a protective factor.
What this paper adds
The overall incidence of neonatal brachial plexus palsy is 1.74 per 1000 live births.
The incidence has declined significantly.
Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are the main risk factors.
Prevention is difficult owing to unpredictability and often labour‐related risk.
Resumen
Factores de riesgo para parálisis braquial neonatal: una revisión sistemática y metaanálisis
Objetivo
Proporcionar una actualización completa en los factores de riesgo más prevalentes y significantes para parálisis braquial neonatal (PBN, parálisis de Erb‐Duchenne).
Metodo
Se realizaron búsquedas en Cochrane CENTRAL, MEDLINE, páginas de ciencia, Embase, y ClinicalTrials.gov para obtener publicaciones relevantes hasta Marzo del 2019. Se incluyeron estudios que evalúan factores de riesgo para PBN en comparación con niños con desarrollo típico. Se realizó un metaanálisis de los primer |
| doi_str_mv | 10.1111/dmcn.14381 |
| format | article |
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To provide a comprehensive update on the most prevalent, significant risk factors for neonatal brachial plexus palsy (NBPP).
Method
Cochrane CENTRAL, MEDLINE, Web of Science, Embase, and ClinicalTrials.gov were searched for relevant publications up to March 2019. Studies assessing risk factors of NBPP in relation to typically developing comparison individuals were included. Meta‐analysis was performed for the five most significant risk factors, on the basis of the PRISMA statement and MOOSE guidelines. Pooled odds ratios (ORs), 95% confidence intervals (CIs), and across‐study heterogeneity (I2) were reported. Reporting bias and quality of evidence was rated. In addition, we assessed the incidence of NBPP.
Results
Twenty‐two observational studies with a total sample size of 29 419 037 live births were selected. Significant risk factors included shoulder dystocia (OR 115.27; 95% CI 81.35–163.35; I2=92%), macrosomia (OR 9.75; 95% CI 8.29–11.46; I2=70%), (gestational) diabetes (OR 5.33; 95% CI 3.77–7.55; I2=59%), instrumental delivery (OR 3.8; 95% CI 2.77–5.23; I2=77%), and breech delivery (OR 2.49; 95% CI 1.67–3.7; I2=70%). Caesarean section appeared as a protective factor (OR 0.13; 95% CI 0.11–0.16; I2=41%). The pooled overall incidence of NBPP was 1.74 per 1000 live births. It has decreased in recent years.
Interpretation
The incidence of NBPP is decreasing. Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are risk factors for NBPP. Caesarean section appears as a protective factor.
What this paper adds
The overall incidence of neonatal brachial plexus palsy is 1.74 per 1000 live births.
The incidence has declined significantly.
Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are the main risk factors.
Prevention is difficult owing to unpredictability and often labour‐related risk.
Resumen
Factores de riesgo para parálisis braquial neonatal: una revisión sistemática y metaanálisis
Objetivo
Proporcionar una actualización completa en los factores de riesgo más prevalentes y significantes para parálisis braquial neonatal (PBN, parálisis de Erb‐Duchenne).
Metodo
Se realizaron búsquedas en Cochrane CENTRAL, MEDLINE, páginas de ciencia, Embase, y ClinicalTrials.gov para obtener publicaciones relevantes hasta Marzo del 2019. Se incluyeron estudios que evalúan factores de riesgo para PBN en comparación con niños con desarrollo típico. Se realizó un metaanálisis de los primeros cinco factores de riesgo más significativos sobre la base de declaración PRISMA y las guías MOOSE. Se informaron los odds ratios (OR) agrupados, los intervalos de confianza (IC) del 95 % y la heterogeneidad entra estudios (I2). Se calificó el sesgo de informe y la calidad de la evidencia. Además, evaluamos la incidencia de PBN.
Resultados
Se seleccionaron 22 estudios observacionales con una muestra total de 29.419.037 nacidos vivos. Los factores de riesgo significantes incluyeron: distocia de hombros (OR 115.27; 95% CI 81.35‐163.35; I2= 92%), macrosomía (OR 9.75; 95% CI 8.29‐11.46; I2= 70%), diabetes gestacional (OR 5.33; 95% CI 3.77‐7.55; I2= 59%), parto instrumental (OR 3.8; 95% CI 2.77‐5.23 I2= 77%) y presentación podálica (OR 2.49; 95% CI 1.67‐3.7; I2= 70%). La cesárea apareció como un factor protector (OR 0.13; 95% CI 0.11‐0.16 I2= 41%). La incidencia global combinada de PBN fue de 1.74 por 1000 nacidos vivos. Ha disminuido en los últimos años.
Interpretacion
La incidencia de PBN está disminuyendo. La distocia de hombros, macrosomía, diabetes gestacional, parto instrumental, y presentación podálica son factores de riesgo para PBN. La cesárea aparece como factor protector.
Resumo
Fatores de risco para paralisia neonatal do plexo braquial: uma revisão sistemática e metanálise
Objetivo
Fornecer uma atualização abrangente sobre os fatores de risco mais prevalentes e significantes para a paralisia neonatal do plexo braquial (PNPP, paralisia de Erb‐Duchenne).
Método
Cochrane CENTRAL, MEDLINE, Web of Science, Embase, e ClinicalTrials.gov foram pesquisados quanto a publicações relevantes até março de 2019. Estudos avaliando os fatores de risco para PNPP em relação a indivíduos com desenvolvimento típico foram incluídos. Foi realizada metanálise para os cinco fatores de risco mais significativos, com base nas diretrizes PRISMA e MOOSE. As taxas de risco agrupadas (TRs), intervalos de confiança a 95% (ICs), e heteogeneidade entre estudos (I2) foram reportados. O viés de relato e qualidade da evidência foram pontuados. Adicionalmente, avaliamos a incidência de PNPP.
Resultados
Vinte e dois estudos observacionais com amostra total de 29.419.037 nascidos vivos foram selecionados. Fatores de risco significativos incluíram distocia de ombro, (TR 115,27; IC 95% 81,35–163,35; I2=92%), macrossomia (TR 9,75; IC 95% 8,29–11,46; I2=70%), diabetes (gestational) (TR 5,33; IC 95% 3,77–7,55; I2=59%), parto instrumental (TR 3,8; IC 95% 2,77–5,23; I2=77%), e apresentação pélvica (TR 2,49; IC 95% 1,67–3,7; I2=70%). Parto cesárea foi um fator protetor (TR 0,13; IC 95% 0,11–0,16; I2=41%). A incidência agrupada geral de PNPP foi 1,74 por 1.000 nascidos vivos. A quantidade diminuiu nos últimos anos.
Interpretação
A incidência de PNPP tem diminuído. Distocia de ombro, macrossomia, diabetes materna, parto instrumental e apresentação pélvica são fatores de risco para PNPP. Parto cesárea parece ser um fator protetor.
What this paper adds
The overall incidence of neonatal brachial plexus palsy is 1.74 per 1000 live births.
The incidence has declined significantly.
Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are the main risk factors.
Prevention is difficult owing to unpredictability and often labour‐related risk.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.
This article is commented on by Gherman on page 662 of this issue.
Editor's Choice
Neonatal brachial plexus palsy results in a high, complex, long‐lasting burden. There is a wide variety in epidemiological reports and the predicting value of classically considered risk factors has been questioned. My Editor’s Choice for the June 2020 issue is this comprehensive systematic review and meta‐analysis of risk factors identified in the literature reporting collectively on nearly 30 million births.1 It clarifies a number of issues and also stresses challenges associated to this type of enterprise, including with regard to appraisal tools.2,3 To date, no intervention has effectively prevented the majority of cases of neonatal brachial plexus palsy.4 Hopefully the presented results will provide a firmer base for designing and studying intervention strategies in the future.
REFERENCES
1. Van der Looven R, Le Roy L, Tanghe E, et al. Risk factors for neonatal brachial plexus palsy: a systematic review and meta‐analysis. Dev Med Child Neurol 2020; 62: 673–83.
2. Rehm A, Thahir A. Validity of a meta‐analysis of risk factors for neonatal brachial plexus palsies. Dev Med Child Neurol 2020; 62: 763.
3. Van der Looven R, Le Roy L, Pauwels N, Vingerhoets G. Critical appraisal tools and rater training in systematic reviews and meta‐analyses. Dev Med Child Neurol 2020 62: 764.
4. Gherman R. Are there specific interventions that may reduce the incidence of neonatal brachial plexus palsy? Dev Med Child Neurol 2020; 62: 662.</description><identifier>ISSN: 0012-1622</identifier><identifier>EISSN: 1469-8749</identifier><identifier>DOI: 10.1111/dmcn.14381</identifier><identifier>PMID: 31670385</identifier><language>eng</language><publisher>England</publisher><ispartof>Developmental medicine and child neurology, 2020-06, Vol.62 (6), p.673-683</ispartof><rights>2019 Mac Keith Press</rights><rights>2019 Mac Keith Press.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3651-5aedaa6c63627494f6ba8d68d278fe903d2a96a58432cdf8eecd32dfe6db2d8e3</citedby><cites>FETCH-LOGICAL-c3651-5aedaa6c63627494f6ba8d68d278fe903d2a96a58432cdf8eecd32dfe6db2d8e3</cites><orcidid>0000-0003-4172-8658</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31670385$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Van der Looven, Ruth</creatorcontrib><creatorcontrib>Le Roy, Laura</creatorcontrib><creatorcontrib>Tanghe, Emma</creatorcontrib><creatorcontrib>Samijn, Bieke</creatorcontrib><creatorcontrib>Roets, Ellen</creatorcontrib><creatorcontrib>Pauwels, Nele</creatorcontrib><creatorcontrib>Deschepper, Ellen</creatorcontrib><creatorcontrib>De Muynck, Martine</creatorcontrib><creatorcontrib>Vingerhoets, Guy</creatorcontrib><creatorcontrib>Van den Broeck, Christine</creatorcontrib><title>Risk factors for neonatal brachial plexus palsy: a systematic review and meta‐analysis</title><title>Developmental medicine and child neurology</title><addtitle>Dev Med Child Neurol</addtitle><description>Aim
To provide a comprehensive update on the most prevalent, significant risk factors for neonatal brachial plexus palsy (NBPP).
Method
Cochrane CENTRAL, MEDLINE, Web of Science, Embase, and ClinicalTrials.gov were searched for relevant publications up to March 2019. Studies assessing risk factors of NBPP in relation to typically developing comparison individuals were included. Meta‐analysis was performed for the five most significant risk factors, on the basis of the PRISMA statement and MOOSE guidelines. Pooled odds ratios (ORs), 95% confidence intervals (CIs), and across‐study heterogeneity (I2) were reported. Reporting bias and quality of evidence was rated. In addition, we assessed the incidence of NBPP.
Results
Twenty‐two observational studies with a total sample size of 29 419 037 live births were selected. Significant risk factors included shoulder dystocia (OR 115.27; 95% CI 81.35–163.35; I2=92%), macrosomia (OR 9.75; 95% CI 8.29–11.46; I2=70%), (gestational) diabetes (OR 5.33; 95% CI 3.77–7.55; I2=59%), instrumental delivery (OR 3.8; 95% CI 2.77–5.23; I2=77%), and breech delivery (OR 2.49; 95% CI 1.67–3.7; I2=70%). Caesarean section appeared as a protective factor (OR 0.13; 95% CI 0.11–0.16; I2=41%). The pooled overall incidence of NBPP was 1.74 per 1000 live births. It has decreased in recent years.
Interpretation
The incidence of NBPP is decreasing. Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are risk factors for NBPP. Caesarean section appears as a protective factor.
What this paper adds
The overall incidence of neonatal brachial plexus palsy is 1.74 per 1000 live births.
The incidence has declined significantly.
Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are the main risk factors.
Prevention is difficult owing to unpredictability and often labour‐related risk.
Resumen
Factores de riesgo para parálisis braquial neonatal: una revisión sistemática y metaanálisis
Objetivo
Proporcionar una actualización completa en los factores de riesgo más prevalentes y significantes para parálisis braquial neonatal (PBN, parálisis de Erb‐Duchenne).
Metodo
Se realizaron búsquedas en Cochrane CENTRAL, MEDLINE, páginas de ciencia, Embase, y ClinicalTrials.gov para obtener publicaciones relevantes hasta Marzo del 2019. Se incluyeron estudios que evalúan factores de riesgo para PBN en comparación con niños con desarrollo típico. Se realizó un metaanálisis de los primeros cinco factores de riesgo más significativos sobre la base de declaración PRISMA y las guías MOOSE. Se informaron los odds ratios (OR) agrupados, los intervalos de confianza (IC) del 95 % y la heterogeneidad entra estudios (I2). Se calificó el sesgo de informe y la calidad de la evidencia. Además, evaluamos la incidencia de PBN.
Resultados
Se seleccionaron 22 estudios observacionales con una muestra total de 29.419.037 nacidos vivos. Los factores de riesgo significantes incluyeron: distocia de hombros (OR 115.27; 95% CI 81.35‐163.35; I2= 92%), macrosomía (OR 9.75; 95% CI 8.29‐11.46; I2= 70%), diabetes gestacional (OR 5.33; 95% CI 3.77‐7.55; I2= 59%), parto instrumental (OR 3.8; 95% CI 2.77‐5.23 I2= 77%) y presentación podálica (OR 2.49; 95% CI 1.67‐3.7; I2= 70%). La cesárea apareció como un factor protector (OR 0.13; 95% CI 0.11‐0.16 I2= 41%). La incidencia global combinada de PBN fue de 1.74 por 1000 nacidos vivos. Ha disminuido en los últimos años.
Interpretacion
La incidencia de PBN está disminuyendo. La distocia de hombros, macrosomía, diabetes gestacional, parto instrumental, y presentación podálica son factores de riesgo para PBN. La cesárea aparece como factor protector.
Resumo
Fatores de risco para paralisia neonatal do plexo braquial: uma revisão sistemática e metanálise
Objetivo
Fornecer uma atualização abrangente sobre os fatores de risco mais prevalentes e significantes para a paralisia neonatal do plexo braquial (PNPP, paralisia de Erb‐Duchenne).
Método
Cochrane CENTRAL, MEDLINE, Web of Science, Embase, e ClinicalTrials.gov foram pesquisados quanto a publicações relevantes até março de 2019. Estudos avaliando os fatores de risco para PNPP em relação a indivíduos com desenvolvimento típico foram incluídos. Foi realizada metanálise para os cinco fatores de risco mais significativos, com base nas diretrizes PRISMA e MOOSE. As taxas de risco agrupadas (TRs), intervalos de confiança a 95% (ICs), e heteogeneidade entre estudos (I2) foram reportados. O viés de relato e qualidade da evidência foram pontuados. Adicionalmente, avaliamos a incidência de PNPP.
Resultados
Vinte e dois estudos observacionais com amostra total de 29.419.037 nascidos vivos foram selecionados. Fatores de risco significativos incluíram distocia de ombro, (TR 115,27; IC 95% 81,35–163,35; I2=92%), macrossomia (TR 9,75; IC 95% 8,29–11,46; I2=70%), diabetes (gestational) (TR 5,33; IC 95% 3,77–7,55; I2=59%), parto instrumental (TR 3,8; IC 95% 2,77–5,23; I2=77%), e apresentação pélvica (TR 2,49; IC 95% 1,67–3,7; I2=70%). Parto cesárea foi um fator protetor (TR 0,13; IC 95% 0,11–0,16; I2=41%). A incidência agrupada geral de PNPP foi 1,74 por 1.000 nascidos vivos. A quantidade diminuiu nos últimos anos.
Interpretação
A incidência de PNPP tem diminuído. Distocia de ombro, macrossomia, diabetes materna, parto instrumental e apresentação pélvica são fatores de risco para PNPP. Parto cesárea parece ser um fator protetor.
What this paper adds
The overall incidence of neonatal brachial plexus palsy is 1.74 per 1000 live births.
The incidence has declined significantly.
Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are the main risk factors.
Prevention is difficult owing to unpredictability and often labour‐related risk.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.
This article is commented on by Gherman on page 662 of this issue.
Editor's Choice
Neonatal brachial plexus palsy results in a high, complex, long‐lasting burden. There is a wide variety in epidemiological reports and the predicting value of classically considered risk factors has been questioned. My Editor’s Choice for the June 2020 issue is this comprehensive systematic review and meta‐analysis of risk factors identified in the literature reporting collectively on nearly 30 million births.1 It clarifies a number of issues and also stresses challenges associated to this type of enterprise, including with regard to appraisal tools.2,3 To date, no intervention has effectively prevented the majority of cases of neonatal brachial plexus palsy.4 Hopefully the presented results will provide a firmer base for designing and studying intervention strategies in the future.
REFERENCES
1. Van der Looven R, Le Roy L, Tanghe E, et al. Risk factors for neonatal brachial plexus palsy: a systematic review and meta‐analysis. Dev Med Child Neurol 2020; 62: 673–83.
2. Rehm A, Thahir A. Validity of a meta‐analysis of risk factors for neonatal brachial plexus palsies. Dev Med Child Neurol 2020; 62: 763.
3. Van der Looven R, Le Roy L, Pauwels N, Vingerhoets G. Critical appraisal tools and rater training in systematic reviews and meta‐analyses. Dev Med Child Neurol 2020 62: 764.
4. Gherman R. Are there specific interventions that may reduce the incidence of neonatal brachial plexus palsy? Dev Med Child Neurol 2020; 62: 662.</description><issn>0012-1622</issn><issn>1469-8749</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kMtOwzAQRS0EoqWw4QOQlwgpxY_Ucdih8pR4SAgkdtHUnohAHsVOKdnxCXwjX4JLC0tmM7M4c-fOJWSXsyEPdWgrUw95LDVfI30eqzTSSZyukz5jXERcCdEjW94_M8akGsWbpCe5SpjUoz55vCv8C83BtI3zNG8crbGpoYWSThyYpyIM0xLfZ55OofTdEQXqO99iBW1hqMO3AucUaksrbOHr4xNqKDtf-G2ykYcF3Fn1AXk4O70fX0RXt-eX4-OryAQvPBoBWgBllFQimI5zNQFtlbYi0TmmTFoBqYKRjqUwNteIxkphc1R2IqxGOSD7S92pa15n6NusKrzBsoTwyMxnQnKW8HAqDujBEjWu8d5hnk1dUYHrMs6yRZLZIsnsJ8kA7610Z5MK7R_6G10A-BKYFyV2_0hlJ9fjm6XoN1wRgKM</recordid><startdate>202006</startdate><enddate>202006</enddate><creator>Van der Looven, Ruth</creator><creator>Le Roy, Laura</creator><creator>Tanghe, Emma</creator><creator>Samijn, Bieke</creator><creator>Roets, Ellen</creator><creator>Pauwels, Nele</creator><creator>Deschepper, Ellen</creator><creator>De Muynck, Martine</creator><creator>Vingerhoets, Guy</creator><creator>Van den Broeck, Christine</creator><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4172-8658</orcidid></search><sort><creationdate>202006</creationdate><title>Risk factors for neonatal brachial plexus palsy: a systematic review and meta‐analysis</title><author>Van der Looven, Ruth ; Le Roy, Laura ; Tanghe, Emma ; Samijn, Bieke ; Roets, Ellen ; Pauwels, Nele ; Deschepper, Ellen ; De Muynck, Martine ; Vingerhoets, Guy ; Van den Broeck, Christine</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3651-5aedaa6c63627494f6ba8d68d278fe903d2a96a58432cdf8eecd32dfe6db2d8e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Van der Looven, Ruth</creatorcontrib><creatorcontrib>Le Roy, Laura</creatorcontrib><creatorcontrib>Tanghe, Emma</creatorcontrib><creatorcontrib>Samijn, Bieke</creatorcontrib><creatorcontrib>Roets, Ellen</creatorcontrib><creatorcontrib>Pauwels, Nele</creatorcontrib><creatorcontrib>Deschepper, Ellen</creatorcontrib><creatorcontrib>De Muynck, Martine</creatorcontrib><creatorcontrib>Vingerhoets, Guy</creatorcontrib><creatorcontrib>Van den Broeck, Christine</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Developmental medicine and child neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Van der Looven, Ruth</au><au>Le Roy, Laura</au><au>Tanghe, Emma</au><au>Samijn, Bieke</au><au>Roets, Ellen</au><au>Pauwels, Nele</au><au>Deschepper, Ellen</au><au>De Muynck, Martine</au><au>Vingerhoets, Guy</au><au>Van den Broeck, Christine</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors for neonatal brachial plexus palsy: a systematic review and meta‐analysis</atitle><jtitle>Developmental medicine and child neurology</jtitle><addtitle>Dev Med Child Neurol</addtitle><date>2020-06</date><risdate>2020</risdate><volume>62</volume><issue>6</issue><spage>673</spage><epage>683</epage><pages>673-683</pages><issn>0012-1622</issn><eissn>1469-8749</eissn><abstract>Aim
To provide a comprehensive update on the most prevalent, significant risk factors for neonatal brachial plexus palsy (NBPP).
Method
Cochrane CENTRAL, MEDLINE, Web of Science, Embase, and ClinicalTrials.gov were searched for relevant publications up to March 2019. Studies assessing risk factors of NBPP in relation to typically developing comparison individuals were included. Meta‐analysis was performed for the five most significant risk factors, on the basis of the PRISMA statement and MOOSE guidelines. Pooled odds ratios (ORs), 95% confidence intervals (CIs), and across‐study heterogeneity (I2) were reported. Reporting bias and quality of evidence was rated. In addition, we assessed the incidence of NBPP.
Results
Twenty‐two observational studies with a total sample size of 29 419 037 live births were selected. Significant risk factors included shoulder dystocia (OR 115.27; 95% CI 81.35–163.35; I2=92%), macrosomia (OR 9.75; 95% CI 8.29–11.46; I2=70%), (gestational) diabetes (OR 5.33; 95% CI 3.77–7.55; I2=59%), instrumental delivery (OR 3.8; 95% CI 2.77–5.23; I2=77%), and breech delivery (OR 2.49; 95% CI 1.67–3.7; I2=70%). Caesarean section appeared as a protective factor (OR 0.13; 95% CI 0.11–0.16; I2=41%). The pooled overall incidence of NBPP was 1.74 per 1000 live births. It has decreased in recent years.
Interpretation
The incidence of NBPP is decreasing. Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are risk factors for NBPP. Caesarean section appears as a protective factor.
What this paper adds
The overall incidence of neonatal brachial plexus palsy is 1.74 per 1000 live births.
The incidence has declined significantly.
Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are the main risk factors.
Prevention is difficult owing to unpredictability and often labour‐related risk.
Resumen
Factores de riesgo para parálisis braquial neonatal: una revisión sistemática y metaanálisis
Objetivo
Proporcionar una actualización completa en los factores de riesgo más prevalentes y significantes para parálisis braquial neonatal (PBN, parálisis de Erb‐Duchenne).
Metodo
Se realizaron búsquedas en Cochrane CENTRAL, MEDLINE, páginas de ciencia, Embase, y ClinicalTrials.gov para obtener publicaciones relevantes hasta Marzo del 2019. Se incluyeron estudios que evalúan factores de riesgo para PBN en comparación con niños con desarrollo típico. Se realizó un metaanálisis de los primeros cinco factores de riesgo más significativos sobre la base de declaración PRISMA y las guías MOOSE. Se informaron los odds ratios (OR) agrupados, los intervalos de confianza (IC) del 95 % y la heterogeneidad entra estudios (I2). Se calificó el sesgo de informe y la calidad de la evidencia. Además, evaluamos la incidencia de PBN.
Resultados
Se seleccionaron 22 estudios observacionales con una muestra total de 29.419.037 nacidos vivos. Los factores de riesgo significantes incluyeron: distocia de hombros (OR 115.27; 95% CI 81.35‐163.35; I2= 92%), macrosomía (OR 9.75; 95% CI 8.29‐11.46; I2= 70%), diabetes gestacional (OR 5.33; 95% CI 3.77‐7.55; I2= 59%), parto instrumental (OR 3.8; 95% CI 2.77‐5.23 I2= 77%) y presentación podálica (OR 2.49; 95% CI 1.67‐3.7; I2= 70%). La cesárea apareció como un factor protector (OR 0.13; 95% CI 0.11‐0.16 I2= 41%). La incidencia global combinada de PBN fue de 1.74 por 1000 nacidos vivos. Ha disminuido en los últimos años.
Interpretacion
La incidencia de PBN está disminuyendo. La distocia de hombros, macrosomía, diabetes gestacional, parto instrumental, y presentación podálica son factores de riesgo para PBN. La cesárea aparece como factor protector.
Resumo
Fatores de risco para paralisia neonatal do plexo braquial: uma revisão sistemática e metanálise
Objetivo
Fornecer uma atualização abrangente sobre os fatores de risco mais prevalentes e significantes para a paralisia neonatal do plexo braquial (PNPP, paralisia de Erb‐Duchenne).
Método
Cochrane CENTRAL, MEDLINE, Web of Science, Embase, e ClinicalTrials.gov foram pesquisados quanto a publicações relevantes até março de 2019. Estudos avaliando os fatores de risco para PNPP em relação a indivíduos com desenvolvimento típico foram incluídos. Foi realizada metanálise para os cinco fatores de risco mais significativos, com base nas diretrizes PRISMA e MOOSE. As taxas de risco agrupadas (TRs), intervalos de confiança a 95% (ICs), e heteogeneidade entre estudos (I2) foram reportados. O viés de relato e qualidade da evidência foram pontuados. Adicionalmente, avaliamos a incidência de PNPP.
Resultados
Vinte e dois estudos observacionais com amostra total de 29.419.037 nascidos vivos foram selecionados. Fatores de risco significativos incluíram distocia de ombro, (TR 115,27; IC 95% 81,35–163,35; I2=92%), macrossomia (TR 9,75; IC 95% 8,29–11,46; I2=70%), diabetes (gestational) (TR 5,33; IC 95% 3,77–7,55; I2=59%), parto instrumental (TR 3,8; IC 95% 2,77–5,23; I2=77%), e apresentação pélvica (TR 2,49; IC 95% 1,67–3,7; I2=70%). Parto cesárea foi um fator protetor (TR 0,13; IC 95% 0,11–0,16; I2=41%). A incidência agrupada geral de PNPP foi 1,74 por 1.000 nascidos vivos. A quantidade diminuiu nos últimos anos.
Interpretação
A incidência de PNPP tem diminuído. Distocia de ombro, macrossomia, diabetes materna, parto instrumental e apresentação pélvica são fatores de risco para PNPP. Parto cesárea parece ser um fator protetor.
What this paper adds
The overall incidence of neonatal brachial plexus palsy is 1.74 per 1000 live births.
The incidence has declined significantly.
Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are the main risk factors.
Prevention is difficult owing to unpredictability and often labour‐related risk.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.
This article is commented on by Gherman on page 662 of this issue.
Editor's Choice
Neonatal brachial plexus palsy results in a high, complex, long‐lasting burden. There is a wide variety in epidemiological reports and the predicting value of classically considered risk factors has been questioned. My Editor’s Choice for the June 2020 issue is this comprehensive systematic review and meta‐analysis of risk factors identified in the literature reporting collectively on nearly 30 million births.1 It clarifies a number of issues and also stresses challenges associated to this type of enterprise, including with regard to appraisal tools.2,3 To date, no intervention has effectively prevented the majority of cases of neonatal brachial plexus palsy.4 Hopefully the presented results will provide a firmer base for designing and studying intervention strategies in the future.
REFERENCES
1. Van der Looven R, Le Roy L, Tanghe E, et al. Risk factors for neonatal brachial plexus palsy: a systematic review and meta‐analysis. Dev Med Child Neurol 2020; 62: 673–83.
2. Rehm A, Thahir A. Validity of a meta‐analysis of risk factors for neonatal brachial plexus palsies. Dev Med Child Neurol 2020; 62: 763.
3. Van der Looven R, Le Roy L, Pauwels N, Vingerhoets G. Critical appraisal tools and rater training in systematic reviews and meta‐analyses. Dev Med Child Neurol 2020 62: 764.
4. Gherman R. Are there specific interventions that may reduce the incidence of neonatal brachial plexus palsy? Dev Med Child Neurol 2020; 62: 662.</abstract><cop>England</cop><pmid>31670385</pmid><doi>10.1111/dmcn.14381</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0003-4172-8658</orcidid><oa>free_for_read</oa></addata></record> |
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| title | Risk factors for neonatal brachial plexus palsy: a systematic review and meta‐analysis |
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