Severe obstetric brachial plexus palsies can be identified at one month of age.

<h4>Objective</h4>To establish whether severe obstetric brachial plexus palsy (OBPP) can be identified reliably at or before three months of age.<h4>Methods</h4>Severe OBPP was defined as neurotmesis or avulsion of spinal nerves C5 and C6 irrespective of additional C7-T1 lesi...

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Autores principales:	Martijn J A Malessy, Willem Pondaag, Lynda J-S Yang, Sonja M Hofstede-Buitenhuis, Saskia le Cessie, J Gert van Dijk
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/e9eee951076d41008328f826fed58055
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spelling	oai:doaj.org-article:e9eee951076d41008328f826fed580552021-11-18T07:36:23ZSevere obstetric brachial plexus palsies can be identified at one month of age.1932-620310.1371/journal.pone.0026193https://doaj.org/article/e9eee951076d41008328f826fed580552011-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22043309/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Objective</h4>To establish whether severe obstetric brachial plexus palsy (OBPP) can be identified reliably at or before three months of age.<h4>Methods</h4>Severe OBPP was defined as neurotmesis or avulsion of spinal nerves C5 and C6 irrespective of additional C7-T1 lesions, assessed during surgery and confirmed by histopathological examination. We first prospectively studied a derivation group of 48 infants with OBPP with a minimal follow-up of two years. Ten dichotomous items concerning active clinical joint movement and needle electromyography of the deltoid, biceps and triceps muscles were gathered at one week, one month and three months of age. Predictors for a severe lesion were identified using a two-step forward logistic regression analysis. The results were validated in two independent cohorts of OBPP infants of 60 and 13 infants.<h4>Results</h4>Prediction of severe OBPP at one month of age was better than at one week and at three months. The presence of elbow extension, elbow flexion and of motor unit potentials in the biceps muscle correctly predicted whether lesions were mild or severe in 93.6% of infants in the derivation group (sensitivity 1.0, specificity 0.88), in 88.3% in the first validation group (sensitivity 0.97, specificity 0.76) and in 84.6% in the second group (sensitivity of 1.0, specificity 0.66).<h4>Interpretation</h4>Infants with OBPP with severe lesions can be identified at one month of age by testing elbow extension, elbow flexion and recording motor unit potentials (MUPs) in the biceps muscle. The decision rule implies that children without active elbow extension at one month should be referred to a specialized center, while children with active elbow extension as well as active flexion should not. When there is active elbow extension, but no active elbow flexion an EMG is needed; absence of MUPs in the biceps muscle is an indication for referral.Martijn J A MalessyWillem PondaagLynda J-S YangSonja M Hofstede-BuitenhuisSaskia le CessieJ Gert van DijkPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 10, p e26193 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Martijn J A Malessy Willem Pondaag Lynda J-S Yang Sonja M Hofstede-Buitenhuis Saskia le Cessie J Gert van Dijk Severe obstetric brachial plexus palsies can be identified at one month of age.
description	<h4>Objective</h4>To establish whether severe obstetric brachial plexus palsy (OBPP) can be identified reliably at or before three months of age.<h4>Methods</h4>Severe OBPP was defined as neurotmesis or avulsion of spinal nerves C5 and C6 irrespective of additional C7-T1 lesions, assessed during surgery and confirmed by histopathological examination. We first prospectively studied a derivation group of 48 infants with OBPP with a minimal follow-up of two years. Ten dichotomous items concerning active clinical joint movement and needle electromyography of the deltoid, biceps and triceps muscles were gathered at one week, one month and three months of age. Predictors for a severe lesion were identified using a two-step forward logistic regression analysis. The results were validated in two independent cohorts of OBPP infants of 60 and 13 infants.<h4>Results</h4>Prediction of severe OBPP at one month of age was better than at one week and at three months. The presence of elbow extension, elbow flexion and of motor unit potentials in the biceps muscle correctly predicted whether lesions were mild or severe in 93.6% of infants in the derivation group (sensitivity 1.0, specificity 0.88), in 88.3% in the first validation group (sensitivity 0.97, specificity 0.76) and in 84.6% in the second group (sensitivity of 1.0, specificity 0.66).<h4>Interpretation</h4>Infants with OBPP with severe lesions can be identified at one month of age by testing elbow extension, elbow flexion and recording motor unit potentials (MUPs) in the biceps muscle. The decision rule implies that children without active elbow extension at one month should be referred to a specialized center, while children with active elbow extension as well as active flexion should not. When there is active elbow extension, but no active elbow flexion an EMG is needed; absence of MUPs in the biceps muscle is an indication for referral.
format	article
author	Martijn J A Malessy Willem Pondaag Lynda J-S Yang Sonja M Hofstede-Buitenhuis Saskia le Cessie J Gert van Dijk
author_facet	Martijn J A Malessy Willem Pondaag Lynda J-S Yang Sonja M Hofstede-Buitenhuis Saskia le Cessie J Gert van Dijk
author_sort	Martijn J A Malessy
title	Severe obstetric brachial plexus palsies can be identified at one month of age.
title_short	Severe obstetric brachial plexus palsies can be identified at one month of age.
title_full	Severe obstetric brachial plexus palsies can be identified at one month of age.
title_fullStr	Severe obstetric brachial plexus palsies can be identified at one month of age.
title_full_unstemmed	Severe obstetric brachial plexus palsies can be identified at one month of age.
title_sort	severe obstetric brachial plexus palsies can be identified at one month of age.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/e9eee951076d41008328f826fed58055
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Severe obstetric brachial plexus palsies can be identified at one month of age.

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