Newborns’ Brachial Plexus Injury: Parent Guide
There are four main types of brachial plexus injuries in newborns:
| Type of Injury | Description |
| Neuropraxia | Mildest form; temporary conduction block due to myelin sheath damage |
| Axonotmesis | More severe; nerve fibers disrupted but myelin sheath intact |
| Neurotmesis | Most severe; complete nerve disruption requiring regeneration |
| Erb’s Palsy (C5-C6) | Upper plexus injury; affects shoulder and elbow flexion |
| Klumpke’s Palsy (C8-T1) | Lower plexus injury; affects wrist and hand function |
| Total Plexus Palsy (C5-T1) | All nerves affected; complete paralysis of the arm |
Neurapraxia is the most common type of nerve injury where the nerves get stretched but not torn. The silver lining is, most kiddos dealing with this bounce back completely in just a few weeks or months.
On the flip side, Neurotmesis is a more serious type of nerve injury that involves the nerves getting torn. Recovery from this might be partial or, in some unfortunate cases, might not happen at all.
Ramping it up, Avulsion is the most severe type of nerve injury where the nerves get ripped right off the spinal cord. Sadly, these injuries are usually permanent.
Then there’s Klumpke’s Palsy, a nerve injury that affects the lower nerves and is often seen with breech deliveries. Babies dealing with Klumpke’s Palsy might show weakness or even paralysis in the hand and forearm.
| Type of Injury | Prognosis |
| Neuropraxia | Most recover fully within 3 months |
| Axonotmesis | Often recovers within months, but may not be complete |
| Neurotmesis | Recovery possible, but often requires surgery and extensive therapy |
| Erb’s Palsy (C5-C6) | Good prognosis, often recovers within 6 months |
| Klumpke’s Palsy (C8-T1) | More challenging prognosis, may require long-term therapy |
| Total Plexus Palsy (C5-T1) | Variable prognosis, depends on severity and treatment |
Additional potential causes of brachial plexus injuries in newborns encompass:
Shoulder dystocia:
This here’s what happens when the little one’s shoulder gets wedged behind the momma’s pelvic bone during birth.
Forceps Delivery: Now and again, forceps are brought into play to lend a hand with the birth. But if they ain’t used proper, they can do some harm to the baby’s nerves.
Vacuum Extraction: This here’s another method used to assist with delivery. But if the vacuum cup ain’t positioned right on the baby’s noggin, it can do a number on the baby’s nerves.
If your baby winds up with NBPP, remember, you ain’t on your own in this. There’s a heap of help out there for you and your baby. Your doc can connect you with experts who can help your baby get better and reach their full potential.
In the interim, there are several proactive measures you can take to aid your baby dealing with NBPP:
Look out for these common signs of a brachial plexus injury in a newborn:
- Weakness or paralysis in the affected arm or hand
- Less movement or feeling in the impacted arm or hand
- The affected arm or hand taking on an odd position
- Trouble moving the fingers or thumb
- No Moro reflex on the side of the injury (the Moro reflex is when the baby spreads and then brings back its arms)
Docs usually spot this injury in a newborn by giving ’em a good once-over and checking out the baby’s medical past. Sometimes, they might also call for tests like X-rays, ultrasounds, or MRIs to make sure of the diagnosis.
| Symptom | Description |
| Weakness or paralysis in the arm or hand | This can affect all or specific muscles in the arm, depending on the severity and location of the injury. Common presentations include: |
| * Erb’s palsy: Arm hangs limp, inability to raise arm above shoulder, weak grip. | |
| * Klumpke’s palsy: Claw hand, weak wrist and finger flexion. | |
| * Total brachial plexus palsy: Complete lack of movement and sensation in the entire arm and hand. | |
| Decreased movement or sensation in the upper extremity | This can range from mild tingling to complete numbness, depending on the nerves affected. |
| Abnormal arm position | The affected arm may be held in a fixed position, such as bent at the elbow and close to the body, or it may hang limply. |
| Absent Moro reflex on the affected side | The Moro reflex is a startled reaction where the baby flings their arms and legs out wide. If this reflex is missing on one side, it could point to a nerve injury in the arm. |
| Decreased grip on the affected side | The baby may have a weak grip or be unable to grasp objects at all. |
| Pain (less common in newborns) | While not as common in newborns, some may experience pain in the affected arm or shoulder. |
| Challenge | Description |
| Upper Limb Weakness | Difficulty using the affected arm and hand due to muscle weakness. |
| Pain and Spasticity | Chronic pain and muscle stiffness in the affected arm and hand. |
| Sensory Loss | Reduced or absent sensation in the affected arm and hand. |
| Joint Deformities | Contractures or dislocations of the joints in the affected arm and hand. |
| Psychological Impact | The emotional ups and downs and social hurdles that come with living with a nerve injury in the arm. |
| Treatment | Advantages |
| Non-operative Management | – Minimally invasive – Allows for spontaneous nerve recovery – Lower risk of complications |
| Nerve Grafting | – Improves functional outcomes for severe injuries – Can restore sensation and function |
| Neurolysis | – Releases pressure on compressed nerves – Can improve nerve function quickly |
| Muscle Transfers | – Provides alternative function for paralyzed muscles – Improves quality of life |
After Surgery Care: After the operation, your little one will need some physical therapy to help get the movement and function back in the arm that’s been affected. This rehab process might take a few months or even longer. But don’t worry, with a whole lot of patience and a strong support system, most kids with these kind of nerve injuries can adjust and lead full and active lives.
What’s the Future Look Like for Newborns with These Nerve Injuries?: The future for a newborn with this kind of nerve injury really depends on how severe the injury is and which specific nerves are involved. While most infants with these injuries tend to bounce back pretty well, there are cases where some may have to deal with lasting weakness or even paralysis in the affected arm or hand.
Monetary Support and Insurance Help for Newborn Arm Nerve Damage
| Insurance/Financial Support | Description |
| Medicare | Takes care of both in-hospital and out-of-hospital treatment for newborn injuries, but you might need to get it okayed first and be ready for co-pays and deductibles. |
| Medicaid | It takes care of the essential medical treatment needed for nerve damage in a newborn’s shoulder area, but the extent of coverage can differ from state to state. |
| Private Insurance | The coverage for nerve damage in a newborn’s shoulder area can differ based on the specific plan. It’s crucial to review your policy for specifics. |
| Children’s Health Insurance Program (CHIP) | Offers health insurance coverage to children with low income, including coverage for nerve damage in the shoulder area. |
| Social Security Disability Insurance (SSDI) | Might offer financial aid to families of newborns with nerve damage in the shoulder area, if the child fulfills specific requirements. |
| Supplemental Security Income (SSI) | Might offer financial help to kids with nerve damage in the shoulder area who have restricted income and resources. |
| Workers’ Compensation | If you got hurt on the job and it’s messing with your arm nerves, your medical bills and lost pay might be taken care of. |
| Birth Injury Lawsuits | Sometimes, if a doc or hospital messes up and it leads to your kid’s arm nerve damage, you might be able to take ’em to court. Parenting a Child with a Brachial Plexus Injury |
Dealing with the challenges of raising a kid with this kind of nerve injury takes a lot of thought and care. It’s super important to remember that, no matter how tough things get, your child deserves all the love and support you can give. Here are some tips from the pros for parents in this situation:
Hang in There: Healing from this kind of nerve injury takes time. Keep your chin up and don’t get discouraged if you don’t see progress right away.
Demonstrate Affection: Offer heightened love and support to your child during this critical period. Communicate your steadfast presence and belief in their potential to overcome challenges.
Acknowledge Incremental Progress: Celebrate even the smallest advancements. Recognizing these victories can serve as a motivating factor for your child, fostering perseverance.
Reach Out for Help: Make use of all the resources you can find that are designed for parents dealing with this kind of nerve injury. Talk to your doctor about finding support groups or online communities where you can hear from others who’ve been in your shoes.
Find Your Tribe: Remember, you’re not alone on this journey. Connect with folks who are going through the same thing. With a little patience, a lot of compassion, and a strong support network, you and your kiddo can get through this and live a full, happy life.
Team Up with the Docs: Always work closely with your child’s medical team. By working together, you can tackle the challenges head-on and make sure your child is as healthy and happy as possible.
Referral Links
Nemours KidsHealth : childrenshospital.org/conditions/brachial-plexus-birth-injury
American Academy of Orthopaedic Surgeons (AAOS) : orthoinfo.aaos.org/en/diseases–conditions/erbs-palsy-brachial-plexus-birth-palsy/
Mayo Clinic : mayoclinic.org/diseases-conditions/brachial-plexus-injury/multimedia/brachial-plexus-anatomy-video/vid-20127973
Hospital Resources:
Children’s Hospital of Philadelphia : chop.edu/centers-programs/brachial-plexus-program
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