Developing data-driven guidelines for the management of neonatal brachial plexus palsy: A single-center experience

Purpose The aim of this article is to highlight recent work from a single institution aimed at establishing data-driven clinical guidelines for both conservative and surgical management of neonatal brachial plexus palsy (NBPP). Methods Retrospective analyses of a prospectively collected database of active range of motion (AROM) measurements of upper extremity movements for all children evaluated for NBPP at a single, multidisciplinary brachial plexus clinic from 2005-2020 were performed. Outcomes of interest were modeled using generalized estimating equations and locally estimated scatterplot smoothing. Results Children evaluated at a specialty clinic within 30 days of life demonstrated improved long-term upper extremity active range of motion compared with those evaluated later, regardless of whether they were managed conservatively or surgically. Intervention before nine months of age was associated with greater upper extremity AROM than later surgical intervention. Motion sensor technology was feasible for capturing patient-initiated arm movements outside the clinical environment and provided objective data that may complement standard clinical assessments. Because the study population involved a rare pathology with limited sample sizes and heterogeneous presentations, specialized statistical approaches were used to account for sparse data and variability across patients. Conclusion NBPP can result in potentially life-long sensory and motor impairments of the upper extremity. Despite an incidence similar to that of cerebral palsy, it remains an understudied pathology. This study suggests that early referral to specialized care and early surgical intervention are associated with improved long-term outcomes in this patient population.