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Updated: Sep 27, 2026
Development of a Neonatal Rat Model for Brachial Plexus Birth Injury
Published on: March 27, 2026
A systematic review of brachial plexus surgery for birth-related brachial plexus injury
P Daniel McNeely1, James M Drake
1Division of Neurosurgery, Department of Surgery, QEII Health Sciences Centre, Dalhousie University, Halifax, NS, Canada.
Insights
Surgery for birth-related brachial plexus palsy lacks conclusive evidence but remains a viable option. Further research is needed to compare surgical outcomes with conservative management for infant brachial plexus injuries.
Area of Science:
- Pediatric Surgery
- Neurology
- Obstetrics
Background:
- Birth-related brachial plexus palsy affects 0.6-2.6 per 1,000 live births.
- Surgical intervention is considered for cases unresponsive to conservative treatment.
Purpose of the Study:
- To review existing literature on birth-related brachial plexus palsy.
- To provide evidence-based recommendations for surgical management.
Main Methods:
- Literature search of Medline and Cochrane Library (1966-2002).
- Inclusion of English-language articles; classification by methodology.
- Review of reference lists for relevant studies.
Main Results:
- Twenty-three papers analyzed; no randomized controlled trials found.
- Limited prospective studies on natural history and surgical outcomes.
- Retrospective series suggest favorable surgical outcomes (Level III/V evidence).
Conclusions:
- No definitive evidence supports surgery over conservative management for birth-related brachial plexus injuries.
- Surgery is a potential treatment option due to some evidence suggesting possible benefits.
- Further high-quality studies are needed to establish definitive treatment guidelines.
Objective:
Brachial plexus injury complicates 0.6-2.6 per 1,000 live births. Surgery is sometimes advocated for patients who fail to improve with conservative management. We reviewed the available literature on birth-related brachial plexus palsy in order to provide recommendations for surgical management, using evidence-based criteria.
Methods:
Studies were identified by searching Medline (1966-2002) and the Cochrane Library using the terms brachial plexus, neonate or infant, surgery and natural history. The reference lists of relevant articles were also reviewed. The search was restricted to articles published in English. Each article was classified according to its methodology. Management recommendations were suggested based on the results of the studies identified and the degree of certainty of the available literature.
Results:
Twenty-three papers were selected for detailed analysis. There are no randomized controlled trials that have investigated the role of brachial plexus surgery in the management of birth-related brachial plexus palsy. Two prospective studies of relevance were found, one describing the natural history of birth-related brachial plexus injury and one evaluating surgery for these patients. The remainder consisted of retrospective case series. Outcomes from surgical series are generally favorable (level III and V evidence). Direct comparison with the natural history could not be inferred from the series reviewed given the lack of controls.
Conclusion:
There is no conclusive evidence showing a benefit of surgery over conservative management approaches in the treatment of patients with birth-related brachial plexus injuries. Surgery remains a valid practice option given the level III and V evidence suggesting a possible benefit of surgery.
