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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Ed. by Bancalari, Eduardo / Chappelle, Joseph / Chervenak, Frank A. / D'Addario , Vincenzo / Genc, Mehmet R. / Greenough, Anne / Grunebaum, Amos / Konje, Justin C. / Kurjak M.D., Asim / Romero, Roberto / Zalud, MD PhD, Ivica


IMPACT FACTOR 2018: 1.361
5-year IMPACT FACTOR: 1.578

CiteScore 2018: 1.29

SCImago Journal Rank (SJR) 2018: 0.522
Source Normalized Impact per Paper (SNIP) 2018: 0.602

Online
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1619-3997
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Volume 37, Issue 2

Issues

An approach to the prediction of neonatal Erb palsy

John E. Deaver
  • 1Departments of Obstetrics and Gynecology, Jamaica Hospital Medical Center and the Weill Cornell Medical College, New York, NY, USA
  • Other articles by this author:
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/ Wayne R. Cohen
  • 2Departments of Obstetrics and Gynecology, Jamaica Hospital Medical Center and the Weill Cornell Medical College, New York, NY, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2008-10-31 | DOI: https://doi.org/10.1515/JPM.2009.021

Abstract

We devised a method to predict risk of neonatal Erb palsy using variables ascertainable before delivery. Multiple logistic regression modeling was used to construct an Erb palsy risk score from a case-control study of 45 consecutive Erb palsy cases and 90 controls. Receiver-operator characteristics identified a range of scores for which likelihood ratios were determined for calculation of predictive values across a range of prior probabilities. In the final model, large estimated fetal weight, gestational diabetes, large maternal body mass index, large weight gain, and black race were associated with 2.3–4.8 times greater odds of Erb palsy. A long second stage had a modest effect on the odds (OR=2.7, P=0.13), unless preceded by a long deceleration phase, which combination increased the odds of Erb palsy to 20.1 (P=0.001). A risk score of 0.72 had a sensitivity of 36% and a specificity of 99%. In a theoretical population with a birth prevalence of brachial plexus palsy of 2.5/1000, application of the risk score would prevent 36% of cases and result in about 14 cesareans for every nerve injury prevented. We conclude that risk scoring using multiple logistic regression coefficients of variables that can be known in time to affect decision-making about mode of delivery has the potential to guide intervention to prevent some Erb palsies.

Keywords: Brachial plexus palsy; Erb palsy; logistic regression; prediction; risk assessment

About the article

Corresponding author: Wayne R. Cohen, MD Jacobi Medical Center Room 1N30 1400 Pelham Parkway South Bronx NY 10461 USA Tel.: +1-718-918-4567 Fax: +1-718-918-8765


Received: 2008-06-10

Revised: 2008-08-04

Accepted: 2008-08-15

Published Online: 2008-10-31

Published Online: 2008-10-31

Published in Print: 2009-03-01


Citation Information: Journal of Perinatal Medicine, Volume 37, Issue 2, Pages 150–155, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/JPM.2009.021.

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