Introduction
A brachial plexus injury in newborns is a condition that occurs when the network of nerves controlling movement and sensation in the shoulder, arm, and hand is damaged during birth. This injury can lead to weakness, loss of movement, or even paralysis in the affected limb. Early recognition and specialized care are crucial for optimizing recovery and supporting both the child and their family.
Causes
Brachial plexus injuries in newborns most often occur during difficult or complicated deliveries. Key contributing factors include:
- Shoulder Dystocia: When the baby’s shoulder becomes lodged behind the mother’s pelvic bone during delivery, excessive stretching of the neck can injure the nerves.
- Large Birth Weight: Babies with higher birth weights are at increased risk.
- Prolonged or Difficult Labor: Complicated or assisted deliveries, such as those involving forceps or vacuum extraction, can increase the risk.
- Breech Presentation: Babies delivered feet or buttocks first are more susceptible to nerve injury.
- Maternal Diabetes: This can increase the likelihood of larger babies and complicated deliveries.
Symptoms
Symptoms of brachial plexus injury in newborns can vary in severity and may include:
- Weakness or Paralysis: The affected arm may be limp or unable to move.
- Decreased Grip Strength: The baby may have a weak or absent grasp reflex on the affected side.
- Loss of Sensation: Reduced or absent feeling in the arm or hand.
- Abnormal Positioning: The arm may be held close to the body with the elbow straight and the hand turned inward (a classic sign known as “waiter’s tip” posture).
- Muscle Atrophy: Over time, lack of use can lead to muscle wasting.
Diagnosis
Diagnosis is based on clinical evaluation and may include:
- Physical Examination: Assessment of arm movement, muscle tone, and reflexes.
- Medical History: Review of the birth process and any complications during delivery.
- Imaging: Ultrasound, MRI, or nerve conduction studies may be used to assess the extent of nerve damage and rule out fractures or other injuries.
Treatment Options
Treatment depends on the severity of the injury and the child’s progress:
- Physical and Occupational Therapy: Early and regular therapy is essential to maintain joint flexibility, prevent contractures, and promote muscle strength and function.
- Observation: Many mild injuries (neuropraxia) improve on their own within weeks to months.
- Surgical Intervention: In cases where there is no improvement after several months, surgery may be considered to repair or graft the damaged nerves.
- Splinting: Splints may be used to support the arm and prevent abnormal positioning.
- Family Support and Education: Parents and caregivers benefit from education on home exercises and how to support their child’s development.
Prevention
While not all cases can be prevented, certain strategies may reduce risk:
- Prenatal Care: Managing maternal health conditions, such as diabetes, and monitoring fetal growth.
- Careful Delivery Techniques: Skilled obstetric care and appropriate use of delivery interventions can help minimize trauma during birth.
- Planned Cesarean Delivery: In some high-risk cases, a cesarean section may be recommended to avoid difficult vaginal delivery.
Takeaway
Brachial plexus injury in newborns is a serious but often treatable condition. Early diagnosis, prompt therapy, and ongoing support are key to maximizing recovery and function. Families should work closely with healthcare providers to ensure the best possible outcomes for their child.