Computational Models for Predicting Neonatal Brachial Plexus Injury During Complicated Birthing

About This Grant

Neonatal brachial plexus palsy (NBPP) is an injury that can occur during childbirth when a baby's head is stuck during delivery, which can cause pulling on the baby's neck and their nerves. How this stretching and pulling affects the nerves is unknown, which makes it difficult for a doctor to predict and prevent NBPP and delays treatment for injured newborns. This project will investigate how the nerves in the neck respond when subjected to various levels of stretch and for different durations. The team will use an animal model that has similarities to human newborns to understand NBPP. By stretching the nerves to different degrees and for varying lengths of time, the team will understand the response of these nerves and the limit when injury occurs. The project will also develop computer simulations that will mimic the conditions during complicated deliveries and allow researchers to estimate the stress the nerves experience during stretching. This study will enable the team to develop a practical tool that doctors can use to better predict NBPP and make informed decisions that reduce the risk of nerve injuries in newborns. The project will also help train the future science and engineering workforce by engaging students in research, fostering interest in STEM fields, and encouraging future contributions to healthcare advancements. NBPP untreated has serious long term impacts including muscle atrophy, impaired bone development, and osteoarthritis. There is a critical knowledge gap correlating the effects of over-extended neck, prolonged delivery, and mechanical forces imposed on the neonatal brachial plexus (NBP) during obstructed delivery. This limits understanding of the injury mechanism and ultimately delays prognosis and appropriate intervention in the affected newborn. This study will address this critical gap by investigating the stress relaxation behavior of the NBP when subjected to clinically relevant magnitude and durations of pre-stretch as observed during prolonged head-to-body delivery. The study will leverage a neonatal animal model to provide biomechanical failure data and structural changes in the NBP that are pre-stretched to a range of stretch magnitudes (10%, 15%, and 20% strains) and duration (90 and 300 seconds) as observed during prolonged delivery in the clinic. The study will also integrate experimental data with computational models of the maternal pelvis and neonate that will serve as a surrogate and help overcome the existing ethical limitations in accessing NBP biomechanical information. By using experimentally obtained viscoelastic properties of the NBP, the computations will evaluate NBP risk factors that include endogenous maternal forces, exogenous clinician-applied forces, and fetopelvic disproportion. This integrated approach will enable a highly translational predictive tool that can simulate prolonged delivery in an over-extended neck and predict NBP strains during birthing. The project will also enable hands-on experience for undergraduate students through design courses and summer research programs and for K-12 students through engineering summer camp programs. This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.