FRACTURED CLAVICLE OF THE NEWBORN IN A POPULATION WITH A HIGH PREVALENCE OF GRAND-MULTIPARITY - ANALYSIS OF 78 CONSECUTIVE CASES

Objective To perform a clinical analysis of newborn babies with a fractured clavicle and investigate the possible role of relative calcium deficiency in the aetiology. Design Prospective descriptive study (clinical aspects); case controlled study (calcium, phosphate, alkaline phosphatase). Setting The Nazareth Hospital, Israel. Subjects All babies with a fractured clavicle detected in the newborn period and their mothers delivered between 23 August 1987 and 22 June 1989. The majority of the population were Arab. Interventions Serum calcium, phosphate and alkaline phosphatase were measured on the third postpartum day in 42 affected babies (with uncomplicated deliveries), their mothers, and a matched group of babies and mothers as controls. Main outcome measures Clinical associations of fractured clavicle of the newborn; statistical comparison of affected group with controls (calcium study). Results The incidence of fractured clavicle was 18.7 per 1000 singleton vaginal births; 38 in the posterior clavicle at delivery, 27 in the anterior, position unascertained in nine. Four (5.2%) occurred in instrumental deliveries, three (3.9%) in assisted breech delivery; shoulder dystocia was noted in 13. The male to female ratio of 51:26 was significantly different but not due to birth weight. Affected babies were significantly heavier than the unaffected population. The incidence was higher in parous mothers older than 25 years of age but there was no evidence of increased incidence with increasing parity. No significant results were obtained in the calcium study between affected babies and their mothers, when compared with controls. Conclusions Fractured clavicle of the newborn is a benign form of birth trauma from which heavier babies are at greater risk. It occurs in 1 to 2% of deliveries, most of these being uncomplicated vaginal births, and is often undetected. There is no evidence for relative calcium deficiency.