Child Neurology: Brachial plexus birth injury: What every neurologist needs to know

School of Medicine, University of California, San Francisco, CA 94143, USA.
Neurology (Impact Factor: 8.29). 08/2011; 77(7):695-7. DOI: 10.1212/WNL.0b013e31822a6874
Source: PubMed


While most often transient, brachial plexus birth injury can cause permanent neurologic injury. The major risk factors for brachial plexus birth injury are fetal macrosomia and shoulder dystocia. The degree of injury to the brachial plexus should be determined in the neonatal nursery, as those infants with the most severe injury--root avulsion--should be referred early for surgical evaluation so that microsurgical repair of the plexus can occur by 3 months of life. Microsurgical repair options include nerve grafts and nerve transfers. All children with brachial plexus birth injury require ongoing physical and occupational therapy and close follow-up to monitor progress.

47 Reads
  • Source
    • "In adults, BPI occurs most commonly in motor vehicle accidents, particularly motorcycles, contact sports and falls. Overall, DR injuries are 10~20 times more common than spinal cord injury (SCI) [13, 26-28]. There is an urgent unmet clinical need for effective therapies that can reduce the extent of the initial injury or, at a later stage, enhance repair. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Injured primary sensory axons fail to regenerate into the spinal cord, leading to chronic pain and permanent sensory loss. Re-entry is prevented at the dorsal root entry zone (DREZ), the CNS-PNS interface. Why axons stop or turn around at the DREZ has generally been attributed to growth-repellent molecules associated with astrocytes and oligodendrocytes/myelin. The available evidence challenges the contention that these inhibitory molecules are the critical determinant of regeneration failure. Recent imaging studies that directly monitored axons arriving at the DREZ in living animals raise the intriguing possibility that axons stop primarily because they are stabilized by forming presynaptic terminals on non-neuronal cells that are neither astrocytes nor oligodendrocytes. These observations revitalized the idea raised many years ago but virtually forgotten, that axons stop by forming synapses at the DREZ.
    09/2012; 21(3):83-93. DOI:10.5607/en.2012.21.3.83
  • Source
    Basic Principles of Peripheral Nerve Disorders, 03/2012; , ISBN: 978-953-51-0407-0
  • [Show abstract] [Hide abstract]
    ABSTRACT: ABSTRACT Objective: The ability to predict birth trauma (BT) based on the currently recognized risk factors is limited and there is little information regarding the short-term neonatal outcome following BT. we aimed to identify risk factors for BT and to evaluate the effect of BT on short term neonatal outcome. Methods: A retrospective, cohort, case-control study of all cases of BT in a single tertiary center (1986-2009). The control group included the two subsequent full-term singleton neonates who did not experienced BT. Short-term neonatal outcome was compared between the groups including Apgar scores, NICU admission, duration of hospitalization and neurologic, respiratory and metabolic morbidity. Results: Out of 118,280 singleton full-term newborns delivered during the study period, 2,874 were diagnosed with BT (24.3/1000). The most frequent types of BT were scalp injuries (63.9%, 15.5/1000) and clavicular fracture (32.1%, 7.7/1000). The following factors were found to be independent risk factors for BT: instrumental delivery (OR 7.5, 95%-CI 6.3-8.9), birth weight, delivery during risk hours, parity, maternal age and neonatal head circumference. Cesarean delivery was the only factor protective of BT (OR 0.2, 95%-CI 0.2-0.3). Neonates in the study group had a prolonged length of hospital stay (3.3 vs. 2.7 days, p=0.001), were more likely to be admitted to the NICU (3.9% vs. 1.9%, p<0.001), and had a higher rate of jaundice (11.9% vs. 7.1%, p<0.001) and neurological morbidity (4.7% vs. 2.3%, p<0.001). Conclusion: Instrumental delivery appears to be responsible for most cases of neonatal birth trauma.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 04/2013; 26(15). DOI:10.3109/14767058.2013.789850 · 1.37 Impact Factor
Show more


47 Reads
Available from