Long-term outcomes and effectiveness of interventions in neonatal brachial plexus palsy: A systematic review

Neonatal brachial plexus palsy (NBPP) is a debilitating condition affecting approximately 1 in 1000 live births and often results in significant upper limb functional impairments. Despite advances in microsurgical techniques, long-term outcomes following various surgical interventions remain heterogeneous and controversial. This systematic review aimed to synthesize the evidence on the effectiveness of surgical treatments for NBPP, with a focus on long-term functional recovery across shoulder, elbow, hand, and wrist domains.

Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we conducted a comprehensive literature search across MEDLINE (via PubMed), Embase, Scopus, Web of Science, and the Cochrane CENTRAL Register of Controlled Trials. We included observational studies, cohort studies, and case series published from 1980 onward that reported long-term outcomes for NBPP.

A total of 965 patients from multiple countries were analyzed, with surgical interventions performed between 1990 and 2018. The mean age at surgery ranged from 0.2 to 7.9 years, with follow-up periods extending from 1 to over 10 years. Functional recovery varied by surgical approach, with nerve grafts and transfers showing significant improvements in upper limb mobility and strength. Shoulder function outcomes demonstrated gains in external rotation, abduction, and overall Mallet Score, while elbow and wrist functions showed enhanced active movement and strength. Hand functionality improved in select cases, though heterogeneity in assessment methods limited direct comparisons. Despite advances in surgical techniques, no single approach proved universally superior, highlighting the need for standardized outcome measures and high-quality prospective studies.

Surgical reconstruction for obstetric brachial plexus palsy provides satisfactory functional recovery. However, outcome assessment remains challenging due to heterogeneous reporting, limiting a standardized evaluation of surgical efficacy. The predominance of retrospective studies and the lack of uniform clinical criteria further restrict the application of evidence-based medicine in this field. While nerve grafts and nerve transfers show promising results, there is no definitive consensus on their superiority, particularly regarding external shoulder rotation and hand function recovery.