Revisiting the incidence of brachial plexus birth injury: a 2021–2024 prospective surveillance study

OBJECTIVE: By implementing a new, real-time reporting surveillance system to capture patients born in an extensive regional healthcare system, the authors evaluated the incidence of brachial plexus birth injury (BPBI). They hypothesized that the true incidence of BPBI is higher than previously reported. METHODS: A prospective surveillance system was established in obstetric units and affiliated tertiary-level neonatal ICUs (NICUs) at 2 sites within the authors' healthcare system to ensure the capture of every BPBI. If the infant was born at either site, this reporting system was used so that the patient underwent evaluation by a brachial plexus surgeon at birth and allowed for continuous follow-up by a multidisciplinary brachial plexus team to prevent losses to follow-up. RESULTS: A total of 392 patients were captured by the reporting system between November 2021 and November 2024. After analysis of the flagged patients, 236 (60.2%) patients had isolated shoulder dystocia; 108 (27.5%) had simultaneous shoulder dystocia and BPBI; 18 (4.6%) had BPBI alone; 11 (2.8%) had shoulder dystocia and a fracture; 10 (2.5%) had BPBI, shoulder dystocia, and a fracture; 3 (0.8%) had isolated humeral or clavicular fracture; 3 (0.8%) had BPBI and a fracture; and 3 (0.8%) had none of the above. Three patients were excluded from analysis due to loss to follow-up. Based on the 9776 live births at the 2 sites during the study period, the incidence of patients diagnosed with a BPBI at birth (n = 142) was calculated to be 14.5 per 1000 live births; 35 patients exhibited persistent BPBI symptoms beyond 2 months of age, resulting in an incidence of 3.6 per 1000 live births for persistent BPBI. CONCLUSIONS: This surveillance system more precisely identifies the incidence of BPBI than previously reported. It reveals the common frequency with which children encounter neuropraxia at birth. This study highlights the need for multidisciplinary institutional implementation of surveillance mechanisms to properly capture each BPBI for appropriate and timely intervention.