Long-term Follow-up of Neonatal Brachial Plexopathy: Psychological and Physical Function in Adolescents and Young Adults

Abstract

Purpose: The prevalence of neonatal brachial plexus palsy (NBPP) has been increasing since the early 1980s. No known studies have examined long-term psychological health and quality of life (QOL) in young adults. The purpose of this study was to investigate the psychosocial and intellectual aspects of NBPP during adolescence into young adulthood. Methods: A total of 31 patients were enrolled in the adolescent group (16 to 18 y) and 25 in the young adult group (23 to 28 y). Clinical assessment included functional ability, range of motion and strength, weight and body mass index, and education level. Patients were administered measures of psychiatric symptomatology, self-concept, QOL, and cognitive function. Results: Narakas injury level for the adolescent group included 11 level I, 6 level II, 8 level III, and 6 level IV. The young adult group had 10 level I, 2 level II, 9 level III, and 4 level IV. The degree of physical impairment determined by the Modified Mallet Classification showed persistent impairment in both groups. The average DASH scores were higher than the normal range for the adolescent and young adult groups. Forty-five percent of the adolescents and 68% of the young adults were either overweight or obese. All received high school diplomas with 20 of the young adults pursuing higher education. Scores on measures of psychiatric symptomatology and self-concept showed that both groups fell within the normal range. QOL for both groups was also within the normal range. All participants scored average to above average on the cognitive assessment. All measurements were patient reported. Conclusions: Patients with NBPP can adapt and participate in most activities. This patient sample demonstrated persistent functional limitations and a higher rate of comorbid obesity. However, these patients function psychologically and cognitively within the normal range and many have pursued higher education. Level of Evidence: Level IV.

Interventions to decrease complications after shoulder dystocia: a systematic review and Bayesian meta-analysis

“…2e7 In addition, children with NBPP are at risk for obesity and for developing psychological and behavioral problems. 8,9 To reduce the risk of NBPP, 3 national guidelines on shoulder dystocia recommend interventional exercises (ie, consisting variably of didactics, communication skills, simulation exercises with mannequins, reviewing the maneuvers to use, debriefing, and documentation) for all staff in the labor and delivery unit because it improves communication skills and reduces the incidence of NBPP associated with shoulder dystocia. 1,10,11 Some reports on the topic of simulated exercise suggest a reduction in the frequency of NBPP after the implementation of training.…”

Clinical and Functional Outcome of Modified Quad Surgery in Adult Obstetric Brachial Plexus Injury Patients: Case Reports

“…Further, in their study, 34 44% of adolescent and 68% of the young adult group were overweight or obese. There was a positive correlation between increased weight, depression, and anxiety.…”

“…Butler et al . 34 recently reported that long term psychological health and quality of life in young adults with birth related plexus injury. Although these patients could adapt and participate in most activities, they showed persistent functional limitations and a higher rate of comorbid obesity.…”

“…Another study 34 found that, while the neurological function of patients remained within the normal range of those within the same age group, their patients displayed high rates of comorbid obesity and continued restriction of movement. Long term symptoms of injury are concerning an investigation relating to the treatment of these adults is pertinent.…”

Brachial Plexus Birth Injuries

“…Ultimately, the treatment of shoulder deformities for BPBI must be individualized to the patient’s current limitations, future goals, and potential for remodeling. In studies of adolescents and young adults, patients function within the normal range of psychiatric symptomatology, quality of life, and cognitive function 86,87 .…”