Incidence of Neonatal Brachial Plexus Palsy in Australia 1993-2013: a population-based study

Background: Neonatal brachial plexus palsy (NBPP) is a rare but important adverse outcome of birth and its management is expensive and time consuming, with a permanent disability resulting in approximately 10% of cases. There is evidence from pooled data that the rate of NBPP may be falling. We used national data to determine whether this is a true finding. Methods: Data from mandated Australian national data collections during the period 1993 until 2013 were searched for injury to the brachial plexus, Erbs paralysis due to birth trauma, and other brachial plexus birth trauma. As a denominator, the total number of live births was obtained for each relevant year. To quantify the risk factors we obtained the number of caesarean sections, instrumental deliveries, live born babies with birth weights of 4000 grams or more, and the proportion of pregnancies complicated by diabetes. Linear regressions and Pearson product-moment correlation coefficients were calculated. Results: The incidence rate of NBPP fell significantly over the 20 year study period. There was no change in the rate of macrosomic babies at birth. The rate of caesarean birth and the percentage of instrumental vaginal deliveries of live born babies increased and there was a significant increase in the percentage of pregnancies complicated by. The strongest correlation was with the increased rate of caesarean section. Conclusion: This study has revealed a significant reduction in the incidence of NBPP nationally. It seems likely that the steady increase in the rate of caesarean section in Australia has been associated with the decline in the rate of NBPP at a national level.