Neonatal brachial plexus and phrenic nerve injury

Bowerson M, Nelson VS, Yang LJ. Diaphragmatic paralysis associated with
neonatal brachial plexus palsy. Pediatr Neurol. 2010 Mar;42(3):234-6.

Abstract
Phrenic nerve palsy can occur in the context of neonatal brachial plexus palsy, yet neither outcomes nor definitive treatment guidelines have been established. Diaphragmatic paralysis alone in the newborn results in significant respiratory sequelae and failure to thrive. Reviewing the available literature revealed little information about the incidence of phrenic nerve palsy associated with neonatal brachial plexus palsy, or whether outcomes are associated with the severity of the brachial plexus palsy. Of patients with brachial plexus palsy evaluated during 2005-2009 (n = 166) at our institution, a minority (2.4%; n = 4) had clinically significant diaphragmatic palsy. Of these, a majority (75%; n = 3) manifested respiratory complications sufficient to warrant diaphragmatic plication. The severity of brachial plexus palsy failed to correlate with severity of respiratory consequences. None of the patients underwent nerve repair or reconstruction. We suggest that diaphragmatic paralysis should not be overlooked during a brachial plexus examination, and diaphragmatic paralysis in the very young may require aggressive intervention before the treatment of brachial plexus palsy.

Yoshida K, Kawabata H. The prognostic value of concurrent phrenic nerve palsy
in newborn babies with neonatal brachial plexus palsy. J Hand Surg Am. 2015
Jun;40(6):1166-9.

Abstract
PURPOSE:
To investigate the prognostic value of concurrent phrenic nerve palsy for predicting spontaneous motor recovery in neonatal brachial plexus palsy.
METHODS:
We reviewed the records of 366 neonates with brachial plexus palsy. The clinical and follow-up data of patients with and without phrenic nerve palsy were compared.
RESULTS:
Of 366 newborn babies with neonatal brachial plexus palsy, 21 (6%) had concurrent phrenic nerve palsy. Sixteen of these neonates had upper-type palsy and 5 had total-type palsy. Poor spontaneous motor recovery was observed in 13 neonates with concurrent phrenic nerve palsy (62%) and in 129 without concurrent phrenic nerve palsy (39%). Among neonates born via vertex delivery, poor motor recovery was observed in 7 of 9 (78%) neonates with concurrent phrenic nerve palsy and 115 of 296 (39%) without concurrent phrenic nerve palsy.
CONCLUSIONS:
Concurrent phrenic nerve palsy in neonates with brachial plexus palsy has prognostic value in predicting poor spontaneous motor recovery of the brachial plexus, particularly after vertex delivery.
TYPE OF STUDY/LEVEL OF EVIDENCE:
Therapeutic IV.