Emerging concepts in the pathophysiology of recovery from neonatal brachial plexus injury

Neonatal brachial plexus injury is a common problem in pediatric neurology, with an incidence of 0.6 to 2.5 per 1000 live births.1-5 Full recovery occurs in 69 to 95% of the patients.1,3-5 Improvement is rapid, with complete resolution of weakness in about 75% by 3 to 4 months of age.1-4 However, 3 to 16% of these infants remain profoundly weak2-5 and later in life have functional disability in the affected arm.2-4,6 Skills of daily living are often impaired and progressive bone and joint deformities may develop.5,6 The introduction of the operating microscope and the advent of microsurgical technique have rekindled interest in neurosurgical treatment of brachial plexus injury, including cases of nerve root avulsion.7-8 In appropriately selected patients, innovative techniques of neurolysis and nerve grafting now offer hope for the severely affected child.8 …