Incidence of Autism Spectrum Disorder and Global Developmental Delay in Infants With Brachial Plexus Birth Injury: An Early Association With Birth Asphyxia.

Abstract

Autism spectrum disorder (ASD) and global developmental delay (GDD) are 2 common central nervous system (CNS) diagnoses in children. We hypothesized that the incidence of ASD and GDD is higher among patients with brachial plexus birth injury (BPBI), and that the subgroup of patients with BPBI and CNS diagnoses would have increased rates of maternal risk factors and birth-related complications. A single institution prospective cohort of 849 patients with BPBI was used. Demographics, perinatal history, maternal factors and treatment, and patient outcomes were recorded. Charts were reviewed for concomitant diagnoses of GDD and ASD. Cohorts were compared regarding demographics and treatment data, and then age and sex-matched to analyze for risk factors. Of 834 unique patients seen for BPBI, 772 met inclusion criteria. Seventeen subjects had a diagnosis of GDD (13) or ASD (4) before the age of 5 years, an incidence of 2.2%, which is not different from the general population incidence of ASD and GDD. After age and sex-matching, a history of birth asphyxia (58% vs. 15%, P <0.05) was most associated with an increased likelihood of ASD or GDD diagnosis. Rates of shoulder dystocia and eventual surgical management did not differ between cohorts. Birth complications, especially birth asphyxia, are associated with GDD/ASD in patients with BPBI. Providers should consider that BPBI and GDD/ASD may coexist in children with a history of a complicated birth. Level IV.