The Studies Of Pathogenesis And Prevention & Cure System On Neonatal Brachial Plexus Palsy

Objective: The aim of this study was to further research for risk factors and pathogenesis of neonatal brachial plexus injury (NBPP), then to establish the prevention and cure system.Method: The international and domestic literatures concerning NBPP were accurately retrieved and systematically analysis to determine the potential risk factors for NBPP. The documents of 102 neonates who suffered from brachial plexus palsy and 2 937 neonates who didn't display brachial plexus palsy were harvested and statistical analysis with SAS 8.1 statistic software,χ2-test and unitary factor & multiple factors Logistic regression analysis were used during statistical analysis. The statistical results were analyzed according to two-sided test (α=0.05). The risk factors for brachial plexus palsy were listed on the basis of literature record and statistical results and were used to write proceeding of neonatal condition monitoring software.Result: 1. The pathogenesis, potential risk factors, the denomination of NBPP, and so on, were indefinite or controversial at present. In order to eliminate misinterpretation the proposition that the name of neonatal brachial plexus palsy (NBPP) replaced that of obstetrical brachial plexus palsy (OBPP) was introduced. 2. NBPP was classified into spontaneous recovery, partial spontaneous restoration and irreversible injury depending on natural restorative degree of the paralysis. 3. Risk factors of NBPP include large birth weight (≧4 000g), dystocia, neonatal asphyxia and instrumental vaginal delivery (forceps delivery, vacuum extraction or above two aided delivery methods). The statistical value of various risk factors was as follows: large birth weight, OR=42.4, 95%CI=19.7-91.3; dystocia, OR=29.0, 95%CI=13.1-64.5; neonatal asphyxia, OR=131.8, 95%CI=52.8-328.9; vacuum extraction, OR=18.6, 95%CI=7.4-46.9; forceps delivery, OR=16.9, 95%CI= 4.9-58.9; above two aided delivery methods, OR=151.7, 95%CI=73.2-207.2. 4. The hypothesis of pathogenesis of NBPP is that the unilateral or bilateral NBPP may result from the effects of various forces, which are intrauterine maladaptation of fetus during prenatal development (such as the position of forearm was unfit for longer term), the endogenous forces during delivering (such as uterine contractions and maternal expulsive forces) and the external forces during delivering (such as excessive or misdirected traction, friction of obstetric canal and hyperextension of the arms). Even the force of resistance during cesarean section also may cause brachial plexus palsy. 5. The danger rating of NBPP from the most dangerous to the security level are divided into gradeⅠ,Ⅱ,ⅢandⅣaccording to the newborns risk factors and the likelihood of the NBPP. This risk classification is called NBPP warn-grading. 6. Early-warning mechanism is that different measures are implemented according to different risk classification of NBPP warn-grading, such as the neonate of gradeⅠwho should be taken into related clinical departments to clear diagnosis through all kinds of inspections and be cured, that of gradeⅡwho should be followed up by monitoring points and if the initial diagnosis is NBPP, it should be reported to the Clinical Center to provide further diagnosis and treatment, or the warning be relieved, and that of gradeⅢandⅣ, although the neonate of the two degrees suffering from NBPP is low, it still can not be ruled out the risk, should be carried out the follow-up by pediatrician and parents, if it is found that the baby appears activities asymmetry or unusual circumstances, attention should be paid and highly suspicious cases should be further diagnosis. 7. Integrity prevention and cure system was excogitated which included organizational structure, primary regulations on administration, service area coverage, neonatal conditions monitoring software, early-warning mechanism etc. The system has good value and application prospects. Once implemented, It will bring about an important breakthrough in prevention, cure and research of NBPP, at the same time it can yield enormous impact for early diagnosis and treatment of many other neonatal diseases.Conclusion: 1. Scientific and standardized terming can lead people to correctly understand and treat the NBPP, which will be conducive to eliminate the ideological shackles of obstetric workers so as to promote prevention and research of NBPP. 2. Neonatal asphyxia was as high risk factor of NBPP as dystocia, large birth weight (≧4 000g) and instrumental vaginal delivery. 3. The computer technology can be used in prevention and cure work of NBPP. The neonatal conditions (also NBPP) monitoring software is the core technology of the NBPP prevention and cure system. 4. The NBPP prevention and cure system can be designed and set up in a region of 50 to 100 million populations that is equivalent to a province in china.