XXXX : incidence, causes, and outcome in the United Kingdom and Republic of Ireland.

@entity39918 @entity1 @entity1266 @entity130
OBJECTIVES: To determine the incidence and study the causes and outcome of @entity39918 ( @entity39918 ). DESIGN: Active surveillance of newborn @entity1 using the British Paediatric Surveillance Unit notification system and follow up study of outcome at 6 months of age. SETTING: The United Kingdom and Republic of Ireland. @entity1 : Newborn @entity1 presenting with a flaccid paresis of the arm (usually one, rarely both) born between April 1998 and March 1999. MAIN OUTCOME MEASURES: Extent of the lesion at birth and degree of recovery at 6 months of age. FINDINGS: There were 323 confirmed cases giving an incidence of 0.42 per 1000 live births (1 in 2300). Significant associated risk factors in comparison with the normal population were @entity1266 (60% v 0.3%), high birth weight with 53% @entity1 weighing more than the 90th centile, and assisted delivery (relative risk (RR) 3.4, 95% confidence interval (CI) 2.9 to 3.9, p = 0.0001). There was a considerably lower risk of @entity39918 in @entity1 delivered by caesarean section (RR 7, 95% CI 2 to 56, p = 0.002). At about 6 months of age, about half of the @entity1 had recovered fully, but the remainder showed incomplete recovery including 2% with no recovery. The relative risk of partial or no recovery in @entity1 with extensive lesions soon after birth compared with those with less extensive lesions was 11.28 (95% CI 2.38 to 63.66, p = 0.000005). CONCLUSIONS: The incidence of @entity39918 in the United Kingdom and Republic of Ireland is strikingly similar to that previously reported nearly 40 years ago. Most cases are due to @entity130 at delivery, which is not necessarily excessive or inappropriate. Given the uncertainty about the appropriate management of these @entity1 , serious consideration should be given to a formal clinical trial of microsurgical nerve repair.
