RESUMO
OBJECTIVE: To determine risk factors for Erb's palsy, with a focus on graphic labour patterns. DESIGN: A case-control study. SETTING: New York City. SAMPLE: A total of 45 consecutive cases of Erb's palsy and 90 controls. METHODS: Pregnancies and labours of neonatal Erb's palsy cases were compared with 90 controls using univariate and multiple logistic regression analysis. MAIN OUTCOME MEASURES: Erb's palsy and shoulder dystocia. RESULTS: Mothers of children with Erb's palsy had a higher term body mass index and more gestational diabetes than those of controls. Even cases without diabetes had higher blood glucose values after a 50-g glucose challenge than did controls. Cases had a higher birthweight and a lower ratio of head-to-thoracic circumference than controls. Shoulder dystocia occurred in 67% of cases and in 2% of controls (P = 0.001). Only 46% of labours had a completely normal dilatation pattern. In a multiple logistic regression model, variables independently associated with brachial plexus injury were long deceleration phase of labour, long second stage, high birthweight, black race, and high neonatal or maternal body mass. CONCLUSIONS: Erb's palsy was frequently preceded by abnormal labour and shoulder dystocia; however, a substantial proportion of cases occurred after normal labour and delivery. Predictive models will be necessary to determine to what extent careful monitoring of the terminal portion of dilatation and of fetal descent and incorporation of maternal body mass and race (all independent risk factors in this study) will help identify fetuses at risk for brachial plexus palsy.
Assuntos
Neuropatias do Plexo Braquial/etiologia , Complicações do Trabalho de Parto/etiologia , Adulto , Índice de Apgar , Peso ao Nascer , Índice de Massa Corporal , Estudos de Casos e Controles , Parto Obstétrico , Distocia/etiologia , Feminino , Teste de Tolerância a Glucose , Humanos , Recém-Nascido , Segunda Fase do Trabalho de Parto , Paridade , Gravidez , Resultado da Gravidez , Análise de Regressão , Fatores de RiscoRESUMO
We reviewed 58 literature reports of neonatal alloimmune thrombocytopenic purpura (NAITP). The mortality rate was 9%. The total incidence of suspected intracranial hemorrhage was 28%. We reviewed 17 sibship cases for the relation of birth order to treatment and outcome. Among firstborn affected infants (n = 17) the mortality rate and incidence of central nervous system sequelae were 24 and 47%, respectively, compared to rates of 5 and 15%, respectively, in their younger affected siblings (n = 20). The improved outcome in the latter group appeared to be related to more frequent cesarean section delivery and more frequent and earlier use of corticosteroids and maternal platelet transfusions in the neonate. Sensitive assays of maternal platelet alloantibody are now available, but they lack specificity for NAITP affecting the current gestation. There are two reports in which sensitive assays revealed rising titers of maternal platelet alloantibody during advancing gestation. We propose further study to determine if this is specific for the antepartum diagnosis of NAITP.
Assuntos
Doenças Autoimunes/imunologia , Púrpura Trombocitopênica/congênito , Corticosteroides/uso terapêutico , Plaquetas/imunologia , Transfusão de Sangue , Cesárea , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Recém-Nascido , Isoanticorpos/análise , Troca Materno-Fetal , Transfusão de Plaquetas , Gravidez , Púrpura Trombocitopênica/genética , Púrpura Trombocitopênica/imunologia , Púrpura Trombocitopênica/terapiaRESUMO
We report a case of a sibling pair with neonatal alloimmune thrombocytopenic purpura. Serial antepartum platelet alloantibody quantitation by an enzyme-linked immunoabsorbent assay revealed rising antibody titers during advancing gestation. We discuss the implications of this finding in the antepartum diagnosis of neonatal alloimmune thrombocytopenic purpura, a rare, but frequently fatal disorder.