Risk Factors for Neonatal Clavicular Fractures: A Population-Based Case-Control Study

Background: Neonatal clavicular fractures represent the most common fracture during delivery. We aimed to define risk factors associated with these fractures in a large population-based database. Methods: Data were extracted from Clalit Health Services' electronic health records from 2000 to 2020. Newborns with clavicular fractures were compared with a healthy control group. The following parameters were compared - for the newborns: sex, birth weight, birth height, and head circumference; for the delivery process: assisted delivery, cesarean section, use of epidural, birth week, and number of fetuses; and for the mother: age at delivery, socioeconomic status, height, weight, and body mass index (BMI). Results: We found a rate of 0.28% for neonatal clavicular fractures (5015 clavicular fractures/1 755 660 deliveries). Male gender and heavier birth weight were found to be significantly associated with clavicular fractures (P <.001). Increased risk was also associated with lower socioeconomic status, baseline weight, and maternal BMI (P <.001 for all). Assisted delivery increased the risk of clavicular fracture (OR = 2.274; 95% CI, 1.661-3.115; P <.0001), while cesarean section and use of epidural were found to be protective (OR = 0.149; 95% CI, 0.086-0.26; P <.0001; and OR = 0.687; 95% CI, 0.0531-0.89; P <.004, respectively). Conclusions: This study provides insight into the risk factors associated with neonatal clavicular fractures on the largest group of patients reported to date.