(444) Obstetric Risk Factors for Severity of Erb’s Palsy

Erb’s palsy is an obstetric complication involving neurological injury to the upper limb of the newborn during vaginal delivery. We investigated the association between obstetrical risk factors for Erb’s palsy and the severity of the injury.

Study Design: A retrospective study was conducted between 2006 to 2016 in a large tertiary hospital. The study population consisted of children diagnosed with Erb’s palsy that were followed at the hospital’s Child Development Clinic (CDC). They were evaluated for motor function at three time periods: at birth, at 4-6 months and at one year of age. Erb’s palsy severity was defined using a score of ≤2 at one or two of the range of motions examined. Obstetrical risk factors and delivery outcomes according to the severity of the injury were assessed from the computerized database. Multivariable logistic regression analysis was performed to control for confounders.

Results: Over the study period, 234 children with Erb’s palsy were evaluated at the CDC, of them 205 had available birth data. Fifty children were defined with severe Erb’s palsy upon the first examination and 102 defined with a non-severe injury. Using a multivariable logistic regression model controlling for confounders, including perineal tear and shoulder dystocia, a clavicle fracture was found to be protective for Erb’s palsy severity upon the first exam (OR=0.16; CI=0.03-0.97, p=0.047). At one year of age, there were 9 children with severe Erb’s palsy and 140 defined with a non-severe injury. Using a multivariable logistic regression model, diabetes was found to be an independent risk factor for a severe injury after one year (OR=0.04; CI=1.06-21.51, p=0.04). Diabetes was also found to be a predictive factor for lack of clinical improvement between examinations.

Conclusion:

A clavicle fracture was found to be protective for Erb’s palsy severity at birth. Diabetes was found to be an independent risk factor for severe Erb’s palsy injury at one year of age. Diabetes was also found to be a predictive factor for lack of clinical improvement.