Objective: To examine the extent of neonatal morbidity and its relation with infant size in newborns diagnosed with clavicular fracture after vaginal birth.
Methods: A retrospective case-control study was performed on all the infants diagnosed with clavicular fractures and born vaginally between July 1997 and June 2000. For each index case, a control matched for gestational age (within l week), birth weight (within 100 g), and delivered within the same 24-hour period (8 AM to 8 AM), was selected at random from the delivery suite registry. If a control could not be identified within the period, the search was extended to the previous or the following 24-hour period, and the birth weight criterion relaxed to within 250 g. The overall neonatal outcome was compared between the two groups and the morbidity was further analyzed according to whether the infants were large for gestational age (LGA) or not.
Results: Clavicular fracture, found in 1.6% (151 of 9540) of vaginal births, was associated with increased incidence of instrumental delivery (P =.001) and shoulder dystocia (P =.013). The associated morbidity were Erb palsy (P =.007), which was more often found in the LGA infants (P =.055), and cephalhematoma (P =.031), which was only found in the non-LGA infants (odds ratio 4.48, 95% confidence interval 1.23, 16.30). On multivariable analysis, clavicular fracture was excluded as a significant factor in these outcomes after adjusting for the effect of instrumental delivery and shoulder dystocia.
Conclusion: Neonatal clavicular fracture is of little clinical significance, and it does not reflect quality of care.