Fractured clavicle and Erb's palsy unrelated to birth trauma☆,☆☆,★

Presented at the Seventeenth Annual Meeting of the Society of Perinatal Obstetricians, Anaheim, California, January 20-25, 1997.
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Abstract

Objectives: Our purpose was to determine the perinatal factors associated with clavicular fracture or Erb's palsy in neonates and to document the percentage of cases where no risk factors were involved. Study Design: We reviewed the medical records of all live-born singleton infants admitted to the newborn nurseries between 1992 and 1995. Mothers and infants with clavicular fracture or Erb's palsy were compared with those without these birth injuries. Results: Of 11,636 neonates, there were 236 (2.03%) with clavicular fracture and 51 (0.44%) with Erb's palsy. Clavicular fracture was significantly associated with shoulder dystocia and high birth weight. Significant factors associated with Erb's palsy were shoulder dystocia, high birth weight, prolonged second stage, instrumental delivery, fetal distress, use of oxytocin, and epidural anesthesia. A total of 51.7% of the neonates with clavicular fracture and 29.4% of those with Erb's palsy had none of the risk factors examined. Conclusions: Although macrosomic fetuses and instrumental or difficult deliveries are risk factors for clavicular fracture and Erb's palsy, >50% and 25%, respectively, occur without the risk factors examined.

Section snippets

Material and methods

All infants admitted to the neonatal nurseries of the Central Emek Hospital undergo physical examination daily by pediatric residents and at least once by a senior staff member before discharge. Fracture of the clavicle was diagnosed by physical examination (crepitus, step-off), with confirmatory x-ray films used only if the diagnosis was in doubt. Erb's palsy was diagnosed in infants showing absent or inadequate Moro reflex with the characteristic inability to externally rotate the arm,

Results

Between 1992 to 1995 there were 11,636 admissions to the neonatal nursery. There were 266 clavicular fractures (2.29%) and 51 Erb's palsies (0.44%). Included in these statistics are the 30 neonates who had both a clavicular fracture and an Erb's palsy (leaving 236 with clavicular fracture only).

Compared with the neonates without birth injury, there was no difference in the gravidity, parity, age, ethnicity, or gestational age of the mothers. Data on maternal weight gain was not available. Also,

Comment

Clavicular fracture and Erb's palsy have classically been considered obstetric injuries, with the implication that most can be avoided. The reported risk factors include increased birth weight and gestational age, shoulder dystocia, instrumental vaginal delivery, and fetal distress.3 Other possible associations include lower parity, increased maternal weight gain, and less obstetric experience of the delivery personnel.3

Strong downward traction of the head in an attempt to deliver the anterior

Acknowledgements

We thank Asha Rijhsinghani for her advice.

References (7)

There are more references available in the full text version of this article.

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From the Department of Obstetrics and Gynecologya and the Neonatal Intensive Care Unit,b Central Emek Hospital, and the Department of Obstetrics and Gynecology, University of Iowa College of Medicine.c

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Reprint requests: David Peleg, MD, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Iowa City, IA 52242-1080.

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0002-9378/97 $5.00+0 6/6/83892

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