WEDNESDAY, March 18 (HealthDay News) -- A newly developed guideline may help determine which infants with obstetrical brachial plexus injury (OBPI) would benefit from surgery, according to a study in the March issue of the Journal of Neurosurgery: Pediatrics.
From a review of the medical literature, James R. Bain, M.D., and colleagues from McMaster Children's Hospital in Hamilton, Ontario, Canada found that 47 to 89 percent of infants with OBPI fell within a gray zone, where it was unclear whether they would benefit from surgery. The recovery rate within the gray zone was 9 to 59 percent. The authors then prospectively evaluated outcomes in 75 infants with OBPI treated at their institution.
The researchers found that 81 percent of infants were in the gray zone at one month of age and 44 percent of these fully recovered. They developed a guideline for surgical intervention for these gray zone patients based on monthly Active Movement Scale cutoff scores for at least two movements: elbow flexion (biceps), shoulder abduction, external rotation shoulder flexion, and wrist extension. Mean scores for the surgery and non-surgery groups differed for elbow flexion and external rotation at three months, while the two groups differed for shoulder abduction and flexion at six months.
"There is compelling evidence that there is a group of infants in whom the present evidence and criteria for surgery do not provide a clear path for decision-making as to the need for surgical intervention," Bain and colleagues conclude. "The guideline presented in this paper provides another framework for decision-making that includes other areas in addition to biceps recovery or elbow function."