Comprehensive approach to newborns and infants with brachial plexus impairment – proposal of Slovenian guidelines

  • Katja Groleger Sršen University Rehabilitation Institute of Republic Slovenia
  • Andrej Repež University Clinical Centre Ljubljana
  • Peter Zorman University Clinical Centre Ljubljana
  • Petja Fister University Clinical Centre Ljubljana
  • irena Štucin Gantar University Clinical Centre Ljubljana
  • Darja Paro Panjan University Clinical Centre Ljubljana
  • Matevž Kržan University Clinical Centre Ljubljana
Keywords: infant, impairment, brachial plexus, comprehensive approach, guidelines

Abstract

The impairment of brachial plexus (IBP) in the neonate and infant remains an important problem. Risk factors for IBP are well known, but the mechanisms of impairment are not yet fully understood. It is important to identify early signs of IBP and to evaluate the hand function. In the guidelines we propose to use the Toronto scale for evaluation of hand function. The newborn with IBP should be referred to physiotherapy, and then regularly followed-up once a month. If the arm and hand function, especially flexion of the elbow, is not improving at the age of two months, the infant should be referred to the tertiary level rehabilitation centre and to department for plastic surgery at the University Medical Centre in Ljubljana. When necessary, the reconstructive procedure should be done by the age of three to six months. After reconstruction of brachial plexus, the child needs a comprehensive therapy program, which involves passive stretching, sensory stimulation, exercises to promote the development of active voluntary movements, bimanual activities, and symmetrical posture and movement patterns.

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Author Biographies

Katja Groleger Sršen, University Rehabilitation Institute of Republic Slovenia

Children´s dept.

PRM specialist

Andrej Repež, University Clinical Centre Ljubljana

Klinični oddelek za plastično, rekonstrukcijsko, estetsko kirurgijo in opekline, Univerzitetni klinični center, Zaloška 1, Ljubljana, Slovenija

spec. plast. krg.

Peter Zorman, University Clinical Centre Ljubljana

Klinični oddelek za plastično, rekonstrukcijsko, estetsko kirurgijo in opekline, Univerzitetni klinični center, Zaloška 1, Ljubljana, Slovenija

 

spec. plast. krg.

Petja Fister, University Clinical Centre Ljubljana

Klinični oddelek za neonatologijo, Pediatrična klinika, Bohoričeva 20, Ljubljana, Slovenija

spec. pediatrije

irena Štucin Gantar, University Clinical Centre Ljubljana

Klinični oddelek za perinatologijo, Ginekološka klinika, UKC, Zaloška 11, Ljubljana, Slovenija

 

spec. pediatrije

 

Darja Paro Panjan, University Clinical Centre Ljubljana

Klinični oddelek za neonatologijo, Pediatrična klinika, Bohoričeva 20, Ljubljana, Slovenija

 

spec. pediatrije

 

Matevž Kržan, University Clinical Centre Ljubljana

Klinični oddelek za otroško, mladostniško in razvojno nevrologijo, Pediatrična klinika, Bohoričeva 20, Ljubljana

References

Evans-Jones G, Kay SP, Weindling AM, Cranny G, Ward A, Bradshaw A et al. Congenital brachial palsy: incidence, causes, and outcome in the United Kingdom and Republic of Ireland. Arch Dis Child Fetal Neonatal Ed 2003; 88: F185-9.

Gherman RB, Ouzounian JG, Goodwin TM. Brachial plexus palsy: an in utero injury? Am J Obstet Gynecol 1999; 180: 1303-7.

International classification of functioning, disability and health: ICF. Geneva, World Health Organization 2001: 12-7.

Smellie W. Collection of Cases and Observation in Mid-Wifery. London 1752; 2: 1754.

Jacquemier JM. Manuel des accouchements et des maladies des femmes grosses et accouchées: contenant les soins à donner aux nouveaux-nés". Paris 1846: 785–6.

Danyau M. Paralysie du membre supérieur, chez le nouveau-né Bull Soc Chir. 1851;2:148.

Duchenne de Boulogne GB. Paralysies obstétricales infantiles des membres supérieurs avec ou sans fractures, luxations ou autres complications. Paris: In: Duchenne de Boulogne GB. De l'électrisation localisée et de son application à la pathologie et à la thérapeutique; Baillière; 1872. pp. 353–66.

Bernard C. Des phénomènes oculo-pupillaires produits par la section du nerf sympathique cervical: ils sont indépendants des phénomènes vasculaires calorifiques de la tête. CR Acad Sci Paris. 1862;55:381–8.

Erb, W. (1874). "Ueber eine eigenthümliche Localisation von Lähmungen im Plexus brachialis". Verhandlungen des naturhistorisch-medicinischen Vereins zu Heidelberg 2: 130–7.

Horner J F. Über eine Form von Ptosis. Klin Monatsblätter Augenheilkunde, Stuttgart. 1869;7:193–8.

Klumpke A. Paralysies radiculaires du plexus brachial, paralysies radiculaires totales, paralysies radiculaires inférieures. De la participation des filets sympathiques oculo-pupillaires dans ces paralysies. Rev Méd Paris. 1885;5:591–616. 739–90.

Fieux G. De la pathologie des paralysies obstétricales chez le nouveau-né. Paralysies obstétricales. Ann Gynecol. 1897;47:52–64.

Doumouchtsis SK, Arulkumaran S. Are all brachial plexus injuries caused by shoulder dystocia? Obstet Gynecol Surv 2009; 64: 615-23.

Jellicoe P, Parsons SJ. Brachial plexus birth palsy. Curr Orthop 2008; 22: 289-94.

Dunham EA. Obstetrical brachial plexus palsy. Orthop Nurs 2003; 22: 106-16.

Wolf H, Hoeksma AF, Oei SL, Bleker OP. Obstetric brachial plexus injury: risk factors related to recovery. Eur J Obstet Gynecol Reprod Biol 2000; 88:133-8.

Bager B. Perinatally acquired brachial plexus palsy-a persisting challenge. Acta Paediatr 1997; 86: 1214-9.

Mollberg M, Hagberg H, Börje B, Häkan L, Ladfors L. High birthweight and shoulder dystocia: the strongest risk factors for obstetrical brachial plexus palsy in a Swedish population-based study. Acta Obstet Gynecol Scand 2005; 84: 654–9.

Golditch IM, Kirkman K. The Large Fetus: Management and Outcome. Obstetrics & Gynecology 1978; 52(1): 26-31.

Levine MH, Holroyde J, Woods JR et al. Birth trauma: Incidence and predisposing factors. Obstet Gynecol 1984; 63: 792-7.

O´Leary JA. Introduction. In: Shoulder dystocia and birth injury: prevention and treatment, 3rd ed. O´Leary JA (ed), Humana Press, 2009: xvii.

Sandmire HF, DeMott RK. Newborn brachial plexus palsy. J Obstet Gynecol 2008; 28: 567-72.

Jennett RJ, Tarby TJ. Brachial plexus palsy: An old problem revisited again II. Cases in point. Am J Obst and Gynec 1997; 176 (6): 1354–13.

Graham EM, Forouzan I, Morgan MA. A retrospective analysis of Erb's palsy cases and their relation to birth weight and trauma at delivery. J Matern Fetal Med. 1997 Jan-Feb;6(1):1-5.

Salonen IS, Uusitalo R. Birth injuries: incidence and predisposing factors. Z Kinderchir 1990;45(3):133-5.

Ouzounian JG, Phelan JP, Korst LM. Permanent Erb palsy: A traction-related injury? Obstet Gynecol 1997; 89: 139–41.

Gonik B, Hollyer V, Allen R. Shoulder dystocia recognition. Am J Perinatol 1991; 8: 31-4.

Sandmire HF, DeMott RK. Erb’s palsy without shoulder dystocia. Int J Gynecol Obstet 2002; 78: 253-6.

Gherman RB, Ouzounian JG, Miller DA, Kwok L, Goodwin TM. Spontaneous vaginal delivery; a risk factor for Erb´s Palsy? Am Obstet Gynecol 1998; 178 (3): 423-7.

Sandmire HF, DeMott RK. Erb’s palsy: concepts of causation. Obstet Gynecol 2000; 95 (6 pt 1): 941-2.

Gonik B, Walker A, Grimm M. Mathematic modeling of forces associated with shoulder dystocia: A comparison of endogenous and exogenous sources. Am J Obstet Gynecol 2000; 182 (3): 689–91.

Gonik B, Zhang N, Grimm MJ. Prediction of brachial plexus stretching during shoulder dystocia using a computer simulation model. Am J Obstet Gynecol. 2003 Oct;189(4):1168-72.

Gonik B, McCormick EM, Verweij BH, Rossman KM, Nigro MA. The timing of congenital brachial plexus injury: A study of electromyography findings in the newborn piglet. Am J Obstet Gynecol 1998;178:688-95.

Frelih J, Neubauer D, Kopač Š, Meglič-Pečarič N. Obporodna poškodba brahialnega pleteža. V: Veličkov H, Neubauer D. Obporodna poškodba brahialnega pleteža. Ljubljana. Knjižica otroške nevrologije 1998: 3-8.

Zafeiriou DI, Psychogiou K. Obstetrical brachial plexus palsy. Pediatr Neurol 2008; 38: 235-42.

Foad SL, Mehlman CT, Ying J. The Epidemiology of Neonatal Brachial Plexus Palsy in the United States. The Journal of Bone & Joint Surgery 2008; 90 (6): 1258-64.

Al-Qattan MM. Obstetric brachial plexus palsy associated with breech delivery. Ann Plastic Surg 2003; 51: 257-64.

vanOuwerkerk WJR, van der Sluijs JA, Nollet F, Barkhof F, Slooff ACJ. Management of obstetric brachial plexus lesions: state of the art and future developments. Childs Nerv Syst 2000; 16(10-11): 638-44.

Narakas AO. Obstetrical brachial plexus injuries. In: Lamb DW (ed): The paralyzed hand. Vol.2.Churchill Livingstone, Edinburg 1987:116-35.

Waters PM. Update on management of pediatric brachial plexus palsy. J Pediatr Orthop B. 2005, 14: 233-44.

van Dijk JG, Pondaag W, Mallessy MJA. Obstetric lesion of the brachial plexus. Muscle Nerve 2001; 24: 1451-61.

Bienstock A. et al. Brachial plexus hand surgery. Updated 2011. Dosegljivo na: www.emedicine.medscape.com/article/1286947.

Gilbert WM, Nesbitt TS, Danielsen B. Associated factors in 1611 cases of brachial plexus injury. Obstet Gynecol 1999; 93(4): 536-40.

Al-Qattan MM, Clarke HM, Curtis CG. Klumpke´s birth Palsy. Does it really exixts? Journal of Hand Surgery 1995; 20B(1): 19-23.

Vredeveld JW, Blaauw G, Slooff BA, et al. The findings in paediatric obstetric brachial palsy differ from those in older patients: a suggested explanation. Dev Med Child Neurol. Mar 2000;42(3):158-61.

Kay SPJ. Obstetrical brachial palsy. Br J Plast Surg 1998;51:43–50.

Medlock MD, Hanigan WT. Neurologic birth trauma. Clin Perinatol 1997;24:845–57.

Sadleir LG, Connolly MB. Acquired brachial plexus neuropathy in the neonate: a rare presentation of late-onset group B streptococcal osteomyelitis. Dev Med Child Neurol 1998;40:496–9.

Birch R. Obstetrical brachial plexus palsy. In: Birch R, Bonney G, Wynne Parry CB, eds. Surgical disorders of the peripheral nerves. Edinburgh: Churchill Livingstone, 1998:212–25.

Stewart RE, Grossman DM, Shulkin BL, et al. Iodine 131-meta-iodo-benzyl-guanidine uptake in infantile myofibromatosis. Clin Nucl Med 1989; 14: 344–6.

Muhlig RS, Blaauw G, Slooff ACJ, Kortleve JW, Tonino AJ. Conservative treatment of obstetrical brachial plexus palsy (OBPP) and rehabilitation. In: Gilbert A (ed). Brachial Plexus Injuries. Martin Dunitz Ltd 2001: 182-96.

Piatt HJ. Birth injuries of brachial plexus. Pediatr Clin N Am 2004; 51: 421-40.

Hale HB, Bae DS, Waters PM. Current Concepts in the Management of Brachial Plexus Birth Palsy. J Hand Surg 2010; 35A: 322–31.

Taniguchi M, Van Heest A, Partington M. Birth Brachial Plexus Injuries: An Update on Evaluation and Treatment. Pediatr Persp 2009; 18(3): 1-4.

Lundborg G, Richard P. Bunge memorial lecture. Nerve injury and repair – a challenge to the plastic brain. J Peripher Nerv Syst 2003; 8:209-26.

Lundborg G. A 25-year perspective of peripheral nerve surgery: evolving neuroscientific concepts and clinical significance. J Hand Surg (Am) 2000; 25:391-414.

Wall JT, Huerta MF, Kaas JH. Changes in the cortical map of the hand following postnatal ulnar and radial nerve injury in monkeys: organization and modification of nerve dominance aggregates. J Neurosci. 1992 Sep;12 (9):3456-65.

Wall JT, Xu J, Wang X. Human brain plasticity: an emerging view of the multiple substrates and mechanisms that cause cortical changes and related sensory dysfunctions after injuries of sensory inputs from the body. Brain Res Brain Res Rev. 2002 Sep;39(2-3):181-215.

Merzenich MM, Jenkins WM. Reorganization of cortical representation of hand following alternations of skin inputs induced by nerve injury, skins islands transfers, and experience. J Hand Surg (Am) 1992: 89-104.

Rosén B, Lundborg G. Sensory re-education after nerve repair: aspects of timing. Handchir Mikrochir Plast Chir. 2004 Feb; 36(1):8-12.

Oud T, Beelen A, Eijffinger E, Nollet F. Sensory re-education after nerve injury of the upper limb: a systematic review. Clin Rehabil. 2007 Jun; 21(6):483-94.

Colon AJ, Vredeveld JW, Blaauv G. Journal of Clinical Neurophysiology 2007; 24(1): 48-51.

Jackson ST, Hoffer MM, Parrish N. Brachial plexus palsy in newborn. J Bone Joint Surg Am. 1988; 70:1217-1220.

Michelow BJ, Clarke HM, Curtis CG, Zuker RM, Seifu Y, Andrews DF. The Natural History of Obstetrical Brachial Plexus Palsy. Plast Reconstr Surg 1994; 93(4): 675-80.

Foad SL, Mehlman CT, Foad MB, Lippert WC. Prognosis following neonatal brachial plexus palsy: an evidence-based review. J Child Orthop 2009; Dec. 3(6): 459-63.

Pondaag W, Malessy MJ, van Dijk JG, Thomeer RT. Natural history of obstetric brachial plexus palsy: a systematic review. Dev Med Child Neurol 2004; 46:138-44.

Hoeksma AF, ter Steeg AM, Nelissen RG, van Ouwerkerk WJ, Lankhorst GJ, de Jong BA. Neurological recovery in obstetric brachial plexus injuries: an historical cohort study. Dev Med Child Neurol 2004; 46:76-83.

Noetzel MJ, Park TS, Robinson S, Kaufman B. Prospective study of recovery following neonatal brachial plexus injury 2001; J Child Neurol 16:488-92.

Seddon H. Nerve injuries. Med Bull (ann arbor) 1965 Jan-Feb; 31: 4-10.

Bahm J, Ocampo-Pavez C, Disselhorst-Klug C, Sellhaus B, Weis J. Obstetric Brachial Plexus Palsy – Treatment Startegy, Long-term results, and Prognosis. Dtsch Arztebl Int. 2009; 106(6): 83-90.

Michelow BJ, Clarke HM, Curtis CG, Zuker RM, Seifu Y, Andrews DF. The Natural History of Obstetrical Brachial Plexus Palsy. Plast Reconstr Surg 1994; 93(4): 675-80.

Jones RHJr. Plexus and nerve root lesions. V: Jones RHJr, Bolton C, Harper M. Pediatric clinical electromyography. Philadelphia, New York, Lippincot-Raven 1996:123-46.

Podnar S, Vodušek DB. Elektrofiziološka obravnava otrok z obporodno poškodbo brahialnega pleteža. V: Veličkov H, Neubauer D. Obporodna poškodba brahialnega pleteža. Ljubljana, Knjižnica otroške nevrologije. Letnik I, Številka 1/1998: 9-14.

Janko M. Elektromiografija v pediatriji. V: Neubauer D, Kopač Š. Zbornik predavanj iz otroške nevrologije. Med Razgl 1998; 37:Suppl 4: 193-8.

Gregorič M. Elektromiografija in sorodne preiskave v rehabilitaciji. Ljubljana, Inštitut RS za rehabilitacijo 1994: 4-31.

Pitt M. What we could be doing in brachial plexus palsy of the newborn: an unproven hypothesis. V: Improving the use of electromyography in pediatrics. 6th International conference. London, UCL Institute of Child Health 2007: 115-6.

Doods SD, Wolfe SW. Perinatal Brachial Plexus Palsy. Current opinion in Paediatrics 2000; 12: 40-7.

Terzis JK, Novikov ML. Radiological and Electrophysiological Detection of Nerve Roots Avulsion in Patients with Birth-Related Brachial Plexus Paralysis. Semin Plast Surg 2005 February; 19 (1): 24–41.

Doi K, Otsuka K, Okamoto Y, Fujii H, Hattori Y, Baliarsing AS. Cervical nerve root avulsion in brachial plexus injuries: magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography. Journal of Neurosurgery: Spine 2002; 96(3): 277-84.

Gilbert A. Indications and strategy. In: Brachial plexus injury, Gilbert A, ed. Martin Dunitz Ltd: 205.

Semel-Concepcion J, Conway A. Neonatal brachial plexus palsies. eMedicine Journal 2001; 2(8): 9.

Kennedy MA. Suture of the brachial plexus in birth paralysis of the upper extremity, BMJ 1903; 7:298–301.

Wickstrom J, Haslam ET, Hutchinson ET. The surgical management of residual deformities of the shoulder following birth injuries of the brachial plexus, J Bone Joint Surg 1955; 27A:27–36.

Tassin JL. Paralysies obstétricales du plexus brachial. Thesis, Université Paris VII, 1984.

Jelerčič N, Groleger Sršen K, Vidmar G. Napovedni dejavniki okrevanja in funkcijsko stanje pet let starih otrok z obporodno poškodbo brahialnega pleteža po konservativni obravnavi. Rehabilitacija 2011; X(2): 23-9.

Gilbert A, Razaboni R, Amar-Khodja S. Indications and results of brachial plexus surgery in obstetrical palsy, Orthop Clin North Am 1988; 19(1):91–105.

Clarke HM, Curtis CG. An approach to obstetrical brachial plexus injuries, Hand Clin 1995; 11(4):563–81.

Strombeck C, Krumlinde-Sundholm L, Forssberg H. Functional outcome at 5 years in children with obstetrical brachial plexus palsy with and without microsurgical reconstruction, Dev Med Child Neurol 2000; 42(3):148–57.

Buesch FE, Schlaepfer B, de Bruin E, Wohlrab G, Ammann-Reiffer C, Meyer-Heim A. Constraint-induced movement therapy for children with obstetric brachial plexus palsy: two single-case series. International Journal of Rehabilitation Research 2010; 33(2): 187-92.

Korelc S, Groleger K, Damjan H, Pihlar Z, Brezovar D. Constraint-induced therapy: a method for the hand function improvement in children with hemiplegic cerebral palsy. V: 16th European Congress of Physical and Rehabilitation Medicine, Brugge, Belgium, June 3-6, 2008. Abstracts, J Rehab Med 2008; suppl. 47: 198.

Basciani M, Intiso D. Botulinum toxin type-A and plaster cast treatment in children with upper brachial plexus palsy. Pediatr Rehabil. 2006 Apr-Jun; 9(2):165-70.

DeMatteo C, Bain JR, Galea V, Gjertsen D. Botulinum toxin as an adjunct to motor learning therapy and surgery for obstetrical brachial plexus injury. Dev Med Child Neurol 2006 Apr;48 (4):245-52.

Ho ES, Roy T, Stephens D, Clarke HM. Serial Casting and Splinting of Elbow Contractures in Children With Obstetric Brachial Plexus Palsy. Journal of Hand Surgery 2010; 35 (1): 84-91.

Published
2015-06-29
How to Cite
1.
Groleger Sršen K, Repež A, Zorman P, Fister P, Štucin Gantar irena, Paro Panjan D, Kržan M. Comprehensive approach to newborns and infants with brachial plexus impairment – proposal of Slovenian guidelines. ZdravVestn [Internet]. 29Jun.2015 [cited 6Apr.2020];84(6). Available from: https://vestnik.szd.si/index.php/ZdravVest/article/view/1238
Section
Quality and safety