Diaphragmatic paralysis in young children: A literature review

Abstract

Diaphragmatic paralysis (DP) is a rare cause of respiratory distress in young children. In the first years of life, the main cause is phrenic nerve injury after cardiothoracic surgery or obstetrical trauma. DP usually presents as respiratory distress. Asymmetrical thorax elevation, difficulty weaning from mechanical ventilation, pulmonary atelectasis, and repeated pulmonary infections are other suggestive signs or complications. DP is usually suspected on chest X‐ray showing abnormal hemidiaphragm elevation. Although fluoroscopy was considered the gold standard for DP confirmation, it has gradually been replaced by ultrasound, which can be done at the bedside. Some electrophysiological tools may be useful for a better characterization of phrenic nerve injury and chance of recovery. The management of DP is mainly based on clinical severity. In mild asymptomatic cases, DP may only require close monitoring. In more severe cases, adequate ventilatory support and/or surgical diaphragmatic plication may be needed. Electrophysiological tools may help clinicians assess the ideal timing for diaphragmatic plication.

Individualized Analysis and Treatment of Difficult Weaning From Ventilation Following Open Cardiac Surgery in Young Children With Congenital Heart Disease

“…The present study also found that severe preoperative pulmonary infection was one of the main causes of weaning difficulties in children after cardiac surgery, which is consistent with previous findings ( 12 ). A single-center, 2-year retrospective cohort study of critically ill pediatric patients by ChoiA et al ( 23 ) showed that severe pulmonary infections were responsible for 74.1% of the disease factors influencing the occurrence of weaning difficulties in children, and a large cross-sectional survey of 40 comprehensive ICUs by Louise Rose et al ( 24 ) found that severe pneumonia, acute lung injury, and severe systemic infections with sepsis were responsible for ~64% of the weaning difficulties.…”

“…After excluding the weaning failure caused by cardiac surgery, we found out the most critical reasons affecting the weaning failure in pediatric patients with congenital heart diseases, although we were unable to establish direct causality between any of these variables and the weaning procedure. Similar findings were previously identified in patients with diverse heart lesions ( 11 , 12 ).…”

“…Weaning difficulties after surgery for infants and children with congenital heart diseases are related to several factors, such as unstable hemodynamics following cardiac surgery, pulmonary hypertension, and delayed awakening ( 9 , 10 ). In most cases, these patients often have accompanying structural health alignments such as tracheal or bronchial stenosis ( 11 ), lung infections, and acquired complications such as post-operative diaphragmatic dysfunctions ( 12 ), which have been identified as influencing factors of weaning difficulty in previous studies. Although there are some studies in the literature analyzing risk factors for extubation failure and how this affects patient outcomes, but there are few studies analyzing the treatment of failed weaning.…”

Diaphragmatic paralysis in a neonate with circumferential skin creases Kunze type

“…Neonatal diaphragmatic paralysis is a rare cause of respiratory distress, traumatic delivery with cervical hyperextension, and/or chest surgery causing phrenic nerve damage (Gerard‐Castaing et al, 2019 ). Birth injury mainly causes unilateral diaphragm injury and is accompanied by ipsilateral brachial plexus injury, resulting in ipsilateral upper limb dyskinesia.…”

Ultrasonographic postoperative evaluation of diaphragm function of patients with congenital heart defects

“…There is no consensus on when or how to intervene in cases of diaphragmatic dysfunction, [15][16][17] Some authors have suggested that this period should be allowed to pass with general supportive treatment, considering that phrenic nerve damage may show spontaneous recovery within one to six weeks. [5,10] On the contrary, Talwar et al [18] recommends a plication procedure as soon as significant diaphragmatic dysfunction is diagnosed.…”