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Early referral to multidisciplinary specialty centers to optimize outcomes in children with neonatal brachial plexus
Whitney E Muhlestein1, Brandon W Smith2, Kate Wan-Chu Chang1
1Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
Insights
Early evaluation for neonatal brachial plexus palsy (NBPP) can improve long-term upper-extremity recovery. Timely referral to specialized centers optimizes outcomes for affected children.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Neonatal brachial plexus palsy (NBPP) affects upper-extremity function in infants.
- Conservative management is common, but optimal timing for specialized evaluation is debated.
- Understanding long-term recovery trajectories is crucial for guiding treatment strategies.
Purpose of the Study:
- To analyze the long-term recovery of upper-extremity movement in children with NBPP.
- To determine if early evaluation (≤30 days) at multidisciplinary centers improves outcomes compared to later evaluation (>30 days).
Main Methods:
- Retrospective analysis of prospectively collected data from 429 children with conservatively managed NBPP (2005-2020).
- Cohort divided into early (≤30 days) and late (>30 days) evaluation groups.
- Active range of motion (AROM) for shoulder and elbow movements compared between groups using locally estimated scatterplot smoothing.
Main Results:
- Elbow flexion improved significantly in both early and late evaluation groups.
- Shoulder abduction, forward flexion, external rotation, and forearm supination improved overall, with greater gains in the early group.
- Elbow extension AROM remained stable in the early group but decreased in the late group; forearm pronation decreased in both groups over time.
Conclusions:
- Children with conservatively managed NBPP generally achieve good long-term shoulder and elbow functional recovery.
- Early referral (≤30 days) to multidisciplinary brachial plexus centers appears to optimize functional outcomes, particularly for shoulder movements.
- Multidisciplinary evaluation is recommended to maximize recovery potential in NBPP.
Aim:
To demonstrate the trajectory of long-term recovery of upper-extremity movement and determine optimal timing of evaluation at multidisciplinary specialty centers in children with neonatal brachial plexus palsy (NBPP).
Method:
All children with conservatively managed NBPP seen at one institution from 2005 to 2020 were considered for inclusion. The cohort was divided according to age at formal evaluation (≤30 or > 30 days). Active range of motion (AROM) for shoulder and elbow movements collected at each appointment were compared in local age windows between early and late cohorts. Locally estimated scatterplot smoothing was used to demonstrate the trajectory of recovery for the overall cohort.
Results:
More than 13 000 prospectively collected data points for 429 children (220 males, 209 females) were analysed. Elbow flexion improved to nearly full AROM for both groups over the course of the study. Shoulder abduction, forward flexion and external rotation, and forearm supination improved for the entire cohort, although greater absolute improvement, particularly at the shoulder, was seen in the early cohort (age at formal evaluation ≤30 days). AROM for elbow extension remained roughly stable for the early cohort but decreased for the late cohort (age at formal evaluation >30 days). AROM for forearm pronation decreased over time for both cohorts.
Interpretation:
Our data demonstrate good long-term functional recovery for children with conservatively managed NBPP. However, early referral to multispecialty brachial plexus centers may optimize outcomes.
What This Paper Adds:
Many children with conservatively managed neonatal brachial plexus palsy have good long-term shoulder and elbow outcomes. Early referral to multidisciplinary clinics may maximize long-term shoulder and elbow recovery and optimize outcomes.
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