Neonatal brachial plexus palsy

Abstract

The most common nerve injury in children is neonatal brachial plexus palsy (NBPP). Nbpp is associated with significant upper extremity impairment and carries with it quality of life impact on the child as well as the entire family. The occurrence of NBPP in the United States is close to 1.5 per 1,000 live births. Thirty to forty percent of these children will suffer permanent upper extremity functional insufficiencies. Nbpp is not a new finding. In the mid-1700s, a physician named William Smellie wrote about a child that presented face-first for delivery. Smellie carefully delivered the child using forceps and noted that the long time spent in the birth canal had rendered the child’s arms paralyzed for several days. By the mid-1800s, NBPP had become known as obstetrical palsy, relating the palsy to delivery. In the late 1800s, a physician named Wilhelm Heinrich Erb posed a significant breakthrough when he described the C5–C6 junction as a common area of injury for NBPP patients. This chapter reviews what might be accepted as the high points of the history and epidemiology of NBPP. Understanding the past allows us to appreciate where we are in the present, and it gives us greater ability to focus on the future. Great strides have been made in just the last decade. There have been significant advances made in virtually all facets of this injury, understanding its incidence and risk factors, basic science insight to bone and muscle growth abnormalities following nerve injury, as well as both primary and secondary surgical reconstructive treatment approaches. The multidimensional physical and psychological challenges of this patient population will continue to merit coordinated multispecialty care for some time to come.