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Prospective study of recovery following neonatal brachial plexus injury
M J Noetzel1, T S Park, S Robinson
1Department of Neurology, Washington University School of Medicine, USA. Noetzel@kids.wustl.edu
Insights
Early strength testing in infants with brachial plexus injury can identify those at risk for long-term arm weakness. This assessment by 6 months helps predict outcomes and guides treatment decisions for neonatal brachial plexus injury.
Area of Science:
- Pediatric Orthopedics
- Neonatal Neurology
- Rehabilitation Medicine
Background:
- Brachial plexus injury at birth affects approximately 1-3 per 1000 live births.
- While most infants recover, about 10% experience persistent profound weakness and functional disability.
- Early identification of at-risk infants is crucial for timely surgical intervention.
Purpose of the Study:
- To evaluate the predictive value of detailed infant strength testing for long-term outcomes in neonatal brachial plexus injury.
- To identify specific strength milestones by 6 months of age that correlate with recovery or permanent disability.
Main Methods:
- A prospective study of 80 infants diagnosed with brachial plexus injury.
- Monthly examinations assessing muscle strength in the affected arm.
- Follow-up to determine long-term functional status and degree of weakness.
Main Results:
- Complete recovery occurred in 66% of infants.
- Mild persistent weakness was noted in 11% of infants.
- Moderate (9%) and severe permanent weakness (14%) were identified, with specific strength deficits by 6 months predicting long-term disability.
Conclusions:
- Detailed muscle strength testing by 6 months of age is a reliable predictor of recovery from neonatal brachial plexus injury.
- This assessment can differentiate infants with favorable prognoses from those likely to experience severe, long-term functional deficits.
- Early identification facilitates appropriate management strategies, including surgical intervention for at-risk infants.
Abstract:
The prognosis for recovery from brachial plexus injury sustained at or before birth is generally favorable. However, roughly 10% of these infants remain profoundly weak and later exhibit functional disability in the affected arm. Early identification of these at-risk infants would be helpful in selecting patients for surgical management. In our prospective study, 80 infants with brachial plexus injury were examined on a monthly basis. Complete recovery occurred in 53 (66%); in 9 (11%), mild weakness persisted. In each child, recovery to antigravity strength in the biceps, triceps, and deltoid was noted by 6 months of age. Moderate arm weakness persisted in 7 children (9%); none had antigravity strength in the deltoid at age 6 months. Eleven children (14%) had severe permanent weakness (mean follow-up: 4.4 years). At age 6 months, these individuals exhibited at best 2/5 strength proximally and typically 0-1/5 strength in the wrist and finger extensors. Our results demonstrate that detailed strength testing up to 6 months of age predicts not only complete recovery of neonatal brachial plexus injury but also those children destined for long-term severe disability.