An unusual case of Erb's palsy in a neonate: a case report

Erb's palsy occurs in neonates following traumatic delivery, where excessive traction on the neck stretches these nerve roots. Nonobstetric causes of Erb's palsy are rare in neonates. The authors report the presentation of a female neonate with Erb's palsy following a postero-lateral thoracotomy. The infant underwent surgery on day 3 of life for esophageal atresia and presented with right upper limb weakness on day 21 of life. She demonstrated features of Erb's palsy with normal higher mental functions. An electromyography and nerve conduction study confirmed Erb's palsy. The surgical procedure in the index case did not involve the brachial plexus. However, her right upper limb was positioned hyperabducted during the intraoperative period, which possibly had led to the palsy. The key message of this report is that prolonged stretching of the brachial plexus roots during surgery of the neck and thorax can be an important nonobstetric cause of Erb's palsy in neonates.