Journal of Child Neurology

 

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Journal of Child Neurology, Vol. 16, No. 7, 488-492 (2001)
DOI: 10.1177/088307380101600705

Prospective Study of Recovery Following Neonatal Brachial Plexus Injury

Michael J. Noetzel, MD

Departments of Neurology and Pediatrics, Washington University School of Medicine, Brachial Plexus Palsy Center St. Louis Children's Hospital, St. Louis, MO

T.S. Park, MD

Department of Neurological Surgery, Washington University School of Medicine, Brachial Plexus Palsy Center St. Louis Children's Hospital, St. Louis, MO

Shenandoah Robinson, MD

Department of Neurological Surgery, Washington University School of Medicine, Brachial Plexus Palsy Center St. Louis Children's Hospital, St. Louis, MO

Bruce Kaufman, MD

Department of Neurological Surgery, Washington University School of Medicine, Brachial Plexus Palsy Center St. Louis Children's Hospital, St. Louis, MO

The prognosis for recovery from brachial plexus injury sustained at or before birth is generally favorable. However, roughly 10% of these infants remain profoundly weak and later exhibit functional disability in the affected arm. Early identification of these at-risk infants would be helpful in selecting patients for surgical management. In our prospective study, 80 infants with brachial plexus injury were examined on a monthly basis. Complete recovery occurred in 53 (66%); in 9 (11%), mild weakness persisted. In each child, recovery to antigravity strength in the biceps, triceps, and deltoid was noted by 6 months of age. Moderate arm weakness persisted in 7 children (9%); none had antigravity strength in the deltoid at age 6 months. Eleven children (14%) had severe permanent weakness (mean follow-up: 4.4 years). At age 6 months, these individuals exhibited at best 2/5 strength proximally and typically 0-1/5 strength in the wrist and finger extensors. Our results demonstrate that detailed strength testing up to 6 months of age predicts not only complete recovery of neonatal brachial plexus injury but also those children destined for long-term severe disability. (J Child Neurol 2001;16:488-492).


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