Neonatal Brachial Plexus Paralysis: A Discussion on the Light of Literature

Neonatal Brachial Plexus Paralysis (PPBN) is defined as a brachial plexus traction or compression injury resulting from dystocic delivery. The incidence of PPBN varies from 0.42 to 5.1% per 1000 births. The lesion occurs in the expulsive period of childbirth, is most often associated with shoulder dystocia, gestational or pre-gestational diabetes and macrosomic fetuses. The lesion resulting from C5-C6 root involvement is the most frequent, affecting around 50 to 60% of the cases, and 80% of these patients have spontaneous recovery. However, around 20 to 30% of patients may develop persistent deficits, with permanent impacts on upper limb function, compromising the child's development; leading to repercussions for their families and for the health system. PPBN is usually diagnosed by clinical examination and usually does not require imaging studies. Initial treatment is conservative based on functional rehabilitation through physical therapy. Sequential physical examination will indicate patients with no recovery of shoulder movement between 3 and 6 months, who may benefit from surgical treatment. The prognosis of PPBN depends on the level (pre- or postganglionic), the extent, severity of the lesion, the speed of recovery and the quality of initial clinical management.