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Prognosis and early management of birth injuries to the brachial plexus.
Twenty-four cases of birth injury to the brachial plexus were seen in 21 infants over 15 years. Obstetric complications were common, and in 11 cases traction was needed to deliver the shoulders. Three out of every four arms fully recovered after exercises. Splints were not needed. Reconstructive procedures were performed on three permanently paralysed arms when the children were aged about 4. There was no way of predicting which patients would recover. The muscles supplied by the suprascapular nerve were paralysed in all patients, and this paralysis persisted in those whose arms failed to recover fully.
Birth injury to the spinal cord.
11 cases of children with birth injury to the spinal cord born between 1960 and 1970 are presented in review and compared to about 200 previously published cases. 8 children presented at delivery with one or both feet and 2 with breech. 9 of these infants were born by difficult extraction and needed resuscitation due to primary asphyxia. One child had an easy vertex delivery without evident risk. Diagnosis was established within the first days of life, based on flaccid motor and sensory paralysis below a defined level, mostly in the cervical or upper thoracic spine, with bladder and bowel paralysis, and confirmed by autopsy or by follow-up study. One child with disruption of the spinal cord above C4 survived only a few hours despite artificial ventilation. 4 children died within the first three years of life, 3 of them due to acute pneumonia. 5 of 6 surviving children were followed regularly and are now 10 to 18 years old. They are ambulant with crutches and are well integrated in their families. 4 children attend normal school, and one girl gets special training for mentally retarded children.
[Functional rehabilitation of the upper extremity in children with sequelae of birth injuries to the brachial plexus using the method of adaptive bioregulation].
The authors report of their experience in the rehabilitation of active functions in the upper extremities of 22 children with sequelae of birth injuries of the shoulder plexi of the Erb type. In order to accelerate the reconstruction of the function of the transplanted trapezius muscle a method of adaptive bioregulations is suggested which permitted to quantify the doses of developed muscular tension and control the movements. The obtained results give ground to positively evaluate this method, based on the principle of external reverse connection in the rehabilitative period following an operation of myolavsanoplastics in children with spquelae of birth injuries of the shoulder joint of the Erb's type.
[X-ray symptomatology and differential diagnosis of functional obstruction of the digestive tract in children induced by birth injuries of the spine and spinal cord].
In 60 mixed-breed white rats and 60 puppies we simulated birth traumas of the cervical spine, the spinal medulla and spinal arteries with ischaemia of the cervical medulla. Clinical, neurological and roentgenological complex investigations of 174 children with similar birth injuries revealed pathogenetic relations between birth trauma of the spine, the medulla and the functional obturations of the intestinal tract as pylorospasms, spastic-hypotonic dyskinesia of the ileum and gastroesophageal reflux. Frequent complications were aspiration pneumonia, reflux oesophagitis, oesophageal stenosis and the development of intestinal invagination due to dysrhythmic iliac peristalsis.
Birth injuries: incidence and predisposing factors.
The incidence of birth-associated major injuries among 14.265 live born infants during seven years is presented. The occurrence of major trauma was 3.16% or 441 injuries in 437 children. The most usual injury was fracture of the clavicle, which occurred in 3.0%, after that brachial plexus injury with occurrence of 0.11%, and fracture of long bones with 0.03%. In addition to that there was one child with facial nerve palsy. Four children had two birth injuries each. The most important causes of brachial plexus injury were macrosomia and shoulder dystocia. Eight of 16 children with brachial plexus injury had shoulder dystocia and six of 16 macrosomia. The frequency of macrosomia in our material of 14.265 children was 4.7%, which is much higher than earlier reports by other authors.
Incidence of persistent birth injury in macrosomic infants: association with mode of delivery.
OBJECTIVE: Our purpose was to determine the incidence of birth injury in a cohort of macrosomic infants (birth weight >4000 gm) and analyze the association between persistent injury and delivery method. STUDY DESIGN: Deliveries of 2924 macrosomic infants were reviewed. Outcomes were compared with those of 16,711 infants with birth weights between 3000 and 3999 gm. RESULTS: Macrosomic infants had a sixfold increase in significant injury relative to controls (relative risk 6.7,95% confidence interval 6.5 to 6.9). Risk of trauma correlated with delivery mode: forceps were associated with a fourfold risk of clinically persistent findings compared with spontaneous vaginal delivery or cesarean section. However, the overall incidence of persistent cases remained low (0.3%); a policy of elective cesarean section for macrosomia would necessitate 148 to 258 cesarean sections to prevent a single persistent injury. Avoidance of operative vaginal delivery would require 50 to 99 cesarean sections per injury prevented. CONCLUSIONS: These findings support a trial of labor and judicious operative vaginal delivery for macrosomic infants.
[Birth injury of the spinal cord].
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Characteristics of physicians who frequently act as expert witnesses in neurologic birth injury litigation.
OBJECTIVE: Much debate surrounds physicians who testify in controversial types of medical malpractice litigation, but little is known about them. We sought to describe characteristics of physicians who frequently act as expert witnesses in neurologic birth injury litigation. METHODS: Using jury verdict reports, we identified 827 cases between 1990 and 2005 involving birth-related neurologic injury to a child. Frequent expert witnesses were defined as those associated with more than 10 cases. From the verdict reports and other public data sources, we compiled case descriptions (injury type and severity, legal outcomes) and characteristics of the frequent witnesses (age, gender, board certification, academic publication record). We analyzed these characteristics by comparing witnesses with each other (plaintiff compared with defendant) and with nationally representative data. RESULTS: Seventy-one frequent witnesses participated in 738 cases (89% of the sample), which paid 2.9 billion US dollars in compensation. Most (56 of 71) testified for one side in at least three fourths of cases, and 40% of cases were located outside the witnesses' home states. Frequent plaintiff witnesses had a higher median annual case rate than their defendant counterparts (2.9 compared with 1.9 cases, P=.002). They were also older (57.2 compared with 50.8 years, P=.007), less likely to have subspecialty board certification (38% compared with 95%, P<.001), and had fewer academic publications (5.0 compared with 53.5, P=.002). CONCLUSION: A small cadre of physicians testifies in most neurologic birth injury litigation, and witnesses tend to act consistently for one side. Plaintiff witnesses have fewer markers of expertise than defendant witnesses. These descriptive and analytical findings may reflect suboptimal expertise or bias in physician expert testimony.
[Birth injury to the organs of the abdominal cavity and retroperitoneal space in the newborn].
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[Largactil in therapy of birth injuries].
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Urban variation in infant mortality from birth injury and atelectasis in England and Wales in 1958-67.
Variations in mortality attributed to birth injury and atelectasis in the 10 years 1958-67 have been investigated for each county borough of England and Wales. It became evident that diagnostic difficulties in separating these two causes must have been such that for statistical purposes they should be combined in a single rate.Variables likely to affect the local rates such as the sex ratio of births, and rates of illegitimacy and immaturity as an ill-defined cause of death appeared to affect the mortality levels in certain towns but not sufficiently to account for the wide variations apparent in those levels. It is concluded that local surveys are necessary in the towns with highest rates to uncover differences in numbers of births in hospital, in obstetric techniques and in quality of medical care.
[Prenatal damage and birth injury].
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Brachial plexus palsy secondary to birth injuries.
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[Prevention of birth injuries].
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[Vesicovaginal fistulas as sequelae of birth injuries].
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