The mechanism of obstetric brachial plexus injury and the role of neurophysiology

Giddins, Grey

doi:10.1258/135626206775212546

Cited by 2 publications

(1 citation statement)

References 14 publications

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“…Although EDx has been established in the assessment of babies with NBPP, its utility for early prognosis remains controversial . Opinions variy from EDx having no value at all to the strong recommendation that all children undergo a combination of EDx techniques to determine which candidates would benefit most from nerve reconstruction surgery . Even the value of intraoperative EDx remains to be determined .…”

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confidence: 99%

Early electrodiagnosis in the management of neonatal brachial plexus palsy: A systematic review

et al. 2019

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Neonatal brachial plexus palsy (NBPP) is a prominent form of newborn morbidity with a potentially disabling persistence. Neurosurgical intervention is indicated in select NBPP patients. Early prognostic assessment would facilitate rational selection of those infants for surgery. We conducted a systematic literature review to determine the prognostic value of early electrodiagnosis (EDx) in NBPP. We included 16 observational studies with a total sample size of 747 children. Risk of bias and quality of evidence were rated. Wide variation was found in EDx techniques, outcome algorithms, and decisionmaking. Nevertheless, the most methodologically sound studies support the use of EDx, at standardized time-frames, as a key prognostic modality for complementing clinical judgment and neuroimaging. An accurate knowledge of the underlying anatomy of the nerve injury helps to counsel families and to guide reconstructive strategy. K E Y W O R D S brachial plexus neuropathy, electrodiagnosis, electrodiagnostic testing, neonatal brachial plexus palsy, prognosis 1 | INTRODUCTION Neonatal brachial plexus palsy (NBPP) is reported to occur in 0.1 to 8.10 per 1000 live births worldwide. 1-6 It is the result of a closed nerve stretch injury to the brachial plexus during the perinatal period. The most common lesions occur within the C5 and C6 spinal nerves (80% of patients), with a smaller group of patients having more extensive lesions, ranging from C5 to C7 and from C5 to T1 (panplexopathy). 7Prevention is difficult due to the unpredictability and multifactorial nature of the risk factors. As severity varies from neurapraxia, axonotmesis, and neurotmesis, to root avulsion, and the extent of injury varies between damage to one nerve or all roots, the impact of neonatal plexopathy ranges from temporary functional impairment to a lifelong total paralysis of one arm. 3,5,[8][9][10][11][12][13][14] Early management includes parental counseling; family support; handling information; splinting; and appropriate, early, and supervised rehabilitation. Neurosurgical intervention is usually undertaken between 3 and 12 months of age in children who have shown little or no significant improvement in the affected muscle groups. 2,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] It is generally agreed that early surgical nerve repair can greatly improve the functional outcome in select patients. 15,20,22,24,[31][32][33] Delay to time of surgery often results in progressive worsening of deformity in the shoulder joint as contractures progress quickly over time in a rapidly growing infant. 34 Surgery in the first months of life is therefore indicated for serious Abbreviations:

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