Clinical Pathways are intended to standardize patient care. Our pathways are informed by the systematic review of current pediatric health care literature and includes risk and benefit assessment of alternative care options. When evidence is not available or weak, standards are developed by consensus agreement among subject matter experts.
Clinical Pathways are updated on a revision schedule. Primary files will always be the most current update. Previous revisions are available upon request from Children’s Mercy Library Services.
NOTE:The Clinical Pathways Collection combines and includes work products previously released as Care Process Models and Clinical Practice Guidelines.
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Birth Brachial Plexus Injury (BBPI): Management of Shoulder Subluxation/Dislocation
Children's Mercy Kansas City
BBPI most often, but not always, occurs during the delivery process as the infant descends through the birth canal and the shoulder becomes lodged on the mother’s pelvic bone. As contraction begins, the infant’s neck and shoulder are stretched which can cause tears or ruptures of the nerves within the brachial plexus thus impacting the sensation and movement of the affected upper extremity. Incidence of brachial plexus injuries in the United States is 0.4 to 4 in 1,000 live births (Abzug, et al., 2018; Foad et al., 2008; Hoeksma et al., 2004; Waters, 1997). Although many of these infants will have spontaneous recovery of their injury within 2 - 3 months, 10 – 30% will have irreversible neuromuscular dysfunction and skeletal deformities (Nikolaou et al., 2011; Waters et al., 1998; Poyhia et al., 2005). One condition that impacts the shoulder specifically in BBPI is glenohumeral dysplasia. Glenohumeral dysplasia is a complex condition involving an imbalance between shoulder muscles, particularly the internal and external rotators. This can lead to progressive joint abnormalities, such as posterior subluxation and dislocation, causing further disruption in the development and function of the shoulder joint (Ruchelsman, et al., 2011; Olofsson, et al., 2019; Moukoko, et al., 2004). Early diagnosis and appropriate treatment are important to manage this condition and prevent complications (Pearl, 2009; Vuillermin & Bauer, 2016).
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Bladder Reconstruction and Mitrofanoffs Enhanced Recovery After Surgery
Children's Mercy Kansas City
