PROSPECTIVE-STUDY OF INCIDENCE AND PREDISPOSING FACTORS FOR CLAVICULAR FRACTURE IN THE NEWBORN

Objective. To determine the incidence of clavicular fractures, associa ted fetal and maternal risk factors and its connection with quality ca re control. Subjects and methods. A total of 3030 newborns delivered v aginally were evaluated for clavicular fractures by three separate phy sicians. The study group included all newborns with fractured clavicle . A control group consisted of 52 newborns delivered vaginallly with n o history of fractures. Maternal records were evaluated for possible p redisposing factors. Results. Forty-six (1.5%) newborns were found to have clavicular fractures. When compared to the control group, they we re found to have a higher birthweight (3710+/-352gm vs 3235+/-405gm) a n older maternal age (30.5+/-5 vs 27.7+/-6), a longer second stage of labor (34 min vs 23 min), higher rate of instrumental deliveries (13/4 6 vs 6/52) and shoulder dystocia (6/46 vs 1/52). Nearly 80% of newborn s with clavicular fractures weighed less than 4000 gm. Multivariate an alysis demonstrated two independent variables; birthweight over 3500 g m and maternal age >29. Conclusion. Clavicular fractures are associate d with higher birthweight, older maternal age, longer second stage of labor, instrumental deliveries and shoulder dystocia. However, in most cases this injury cannot be predicted prior to delivery and thus cann ot be an indicator of quality control.