I am well aware that injuries of the brachial plexus occurring at birth have been fully described in the medical literature. There are, however, certain complications of the condition that apparently have escaped notice, and that are of more frequent occurrence than the reports in the literature indicate. It is with this in mind that I have reported and discussed the following case of palsy of the phrenic nerve due to injury of the brachial plexus at birth. REPORT OF A CASEHistory.\p=m-\S.G., a girl, aged 3\ m=1/ 2\ 2 months, was brought to me on Sept. 9, 1924, because of failure to gain in weight. The mother was a primipara whose labor had been unusually difficult and prolonged. Because of a full breech presentation, the services of a consulting obstetrician were required for the extraction of the head. Resuscitation of the infant was readily accomplished, and the cyanosis, considerable at birth, gradually disappeared. The respiratory rate, however, continued to be accelerated and somewhat irregular. A fracture of the upper third of the left humérus, sustained at birth, healed with perfect function. Within a few days, an Erb-Duchenne paralysis of the upper right extremity manifested itself, but improved considerably under mechanotherapy.The infant weighed 3,200 Gm. at birth. The breast feedings, given at three hour intervals, were poorly taken. Because of difficulty in breathing, the child was compelled to interrupt its feedings for periods of rest.Physical Examination.-The infant was fairly well nourished, weighing 4.160 Gm., and had developed normally except in the following particulars. The chest was somewhat flattened in the anterior-posterior diameter ; the middle of the sternum retracted with each inspiration ; the excursion of the right side of the chest was considerably impaired and lagged, this side moving as a whole and lacking the rhythmical, wavy expansion of the ribs ; the left side of the chest appeared long and thin, the ribs descending in an oblique direction with the interspaces considerably narrowed, while the right side appeared full and short, the ribs occupying a horizontal position and the interspaces being wider than normal. Respiration was irregular and rapid, at times 90 a minute. Posteriorly, at each inspiration retraction of the interspaces of the left side was noticeable. Percussion showed hyperresonance throughout the left side of the chest, the lower margin of the lung reaching the eleventh rib posteriorly. The right side of the chest presented impairment of resonance from the midscapular region to the base of the lung, simulating-a consolidation. Anteriorly, the dulness extended from the fourth rib to the costal margin. Auscultation revealed normal breath sounds over the left side of the chest; over the dull area in the right side of the chest the breath sounds were diminished and at the base were entirely absent. Vocal and tactile fremitus were diminished, but no râles were heard. The left border of the heart was at the nipple line in the fourth interspace; the right border was di...
Death from cerebral hemorrhage occurring a week or more after birth and due to an injury presumably sustained at birth is rare in infants who show no signs of cerebral hemorrhage at birth and who develop normally until death. Two such cases in the literature were reviewed in 1929 by Glaser,1 who added a third of his own. Since then, so far as we have been able to determine, no other cases of this nature have been reported. The one described, because of the rarity of the occurrence, and because of the lessons which may perhaps be drawn from it, is considered worthy of reporting in an attempt to add to the knowledge of this fortunately uncommon condition.The infant was first seen by the pediatric consultants at the age of 8 days. A ritual circumcision had been performed by an experienced mohel about six hours previously. Shortly afterward the infant started bleeding profusely and steadily from the site of the operation. Local measures, as well as the intramuscular injection of some of the mother's blood, proved ineffective in controlling the bleeding. Transfusion was deemed necessary as a life-saving measure. Both mother and child belonged to group 3 (Moss), and cross-matching by two physi¬ cians working independently showed the bloods to be compatible. The infant's red corpuscle count was 3,770,000 and his hemoglobin content 70 per cent Sahli.Transfusion was started through a vein in the scalp, the blood being given through a syringe 4 cc. at a time and very slowly because of the small size of the vein and of the needle used. In thirty-five minutes 54 cc. of blood and 20 cc. of physiologic solution of sodium chloride were given. There was the usual amount of struggling on the part of the child, but the procedure was going smoothly when he suddenly became cyanotic. Transfusion was immediately discontinued. Respirations ceased, and occasional cardiac sounds were heard only a moment or From the departments of pediatrics and obstetrics of the University of Rochester School of Medicine and Dentistry and the department of obstetrics of the Rochester General Hospital.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.