Erb palsy due to birth injury (a draft of the clinical recommendations)
- Authors: Ivanov D.O.1, Palchik A.B.1, Fomina M.Y.1, Ponyatishin A.E.1, Minin A.V.1
-
Affiliations:
- Saint Petersburg State Pediatric Medical University
- Issue: Vol 15, No 4 (2024)
- Pages: 111-124
- Section: Draft clinical recommendations
- URL: https://journal-vniispk.ru/pediatr/article/view/279245
- DOI: https://doi.org/10.17816/PED154111-124
- ID: 279245
Cite item
Abstract
The article presents a draft of clinical recommendations for the diagnosis and treatment of Erb palsy in birth injury. These recommendations are intended for physicians of maternity hospitals and are aimed at providing information support for decision-making by a doctor in the event of a birth injury, as well as improving the quality of medical care to a patient. The recommendations correspond to the latest scientific data on the topic, and also contain information that is of an applied nature for practical activities. These practical recommendations are offered for public discussion and are posted in full on the website of the Ministry of Health of the Russian Federation. The recommendations contain an information note on Erb palsy in birth injury, including the definition, etiology and pathogenesis of the disease. Three types of classification of generic traumatic lesions of the brachial plexus are presented: by prevalence, by severity of nerve damage and by severity of paresis. The clinical features of the disease are considered in detail. To diagnose the disease, an algorithm of physical examination is proposed, and the use of instrumental research methods: MRI, ultrasonic, X-ray and electromyographic studies. Recommendations for the conservative treatment of pathology and the use of physiotherapy and rehabilitation techniques are given. An algorithm of the doctor’s actions and an information certificate about the disease are proposed to inform the patient’s parents. The recommendations are given taking into account the level of credibility of the recommendations and the level of reliability of the evidence.
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##article.viewOnOriginalSite##About the authors
Dmitry O. Ivanov
Saint Petersburg State Pediatric Medical University
Author for correspondence.
Email: doivanov@yandex.ru
ORCID iD: 0000-0002-0060-4168
SPIN-code: 4437-9626
MD, PhD, Dr. Sci. (Medicine), Professor, Chief Freelance Neonatologist of the Ministry of Health of Russia, Rector, Head of the Department of Neonatology with courses of Neurology and Obstetrics and Gynecology of Faculty of Retraining and Additional Professional Education
Russian Federation, 2 Litovskaya st., Saint Petersburg, 194100Alexander B. Palchik
Saint Petersburg State Pediatric Medical University
Email: xander57@mail.ru
ORCID iD: 0000-0001-9073-1445
SPIN-code: 1410-4035
MD, Dr. Sci. (Medicine), Professor of the Department of Neonatology with courses in Neurology and Obstetrics of Gynecology at the Faculty of Postgraduate and Additional Professional Education
Russian Federation, 2 Litovskaya st., Saint Petersburg, 194100Maria Yu. Fomina
Saint Petersburg State Pediatric Medical University
Email: myfomina@mail.ru
ORCID iD: 0000-0001-6244-9450
SPIN-code: 2463-2127
MD, Dr. Sci. (Medicine), Professor of the Department of Neonatology with courses in Neurology and Obstetrics of Gynecology at the Faculty of Postgraduate and Additional Professional Education
Russian Federation, 2 Litovskaya st., Saint Petersburg, 194100Andrey E. Ponyatishin
Saint Petersburg State Pediatric Medical University
Email: aponyat@mail.ru
ORCID iD: 0009-0009-9154-6781
SPIN-code: 5000-2299
MD, PhD, Associate Professor of the Department of Neonatology with courses in Neurology and Obstetrics of Gynecology at the Faculty of Postgraduate and Additional Professional Education
Russian Federation, 2 Litovskaya st., Saint Petersburg, 194100Alexey V. Minin
Saint Petersburg State Pediatric Medical University
Email: alexey_minin@mail.ru
SPIN-code: 4533-1166
MD, PhD, Associate Professor of the Department of Neonatology with courses in Neurology and Obstetrics of Gynecology at the Faculty of Postgraduate and Additional Professional Education
Russian Federation, 2 Litovskaya st., Saint Petersburg, 194100References
- Vlasiuk VV, Ivanov DO. Clinical recommendations on diagnosis and treatment of birth trauma (draft). RASPM; 2016. 28 p. (In Russ.)
- Volpe JJ, El-Dib M. Chapter 40 — Injuries of extracranial, cranial, intracranial, spinal cord, and peripheral nervous system structures. In: Volpe JB, editor. Volpe’s neurology of the newborn, 7th edit. Elsevier; 2025. P. 1251–1282. doi: 10.1016/B978-0-443-10513-5.00040-1
- Gonik B, Walker AM, Grimm M. Mathematic modeling of forces associated with shoulder dystonia: a comparison of endogenous and exogenous sources. Am J Obstet Gynecol. 2000;182(3):689–691. doi: 10.1067/mob.2000.104214
- Gherman RB, Ouzounian JG, Goodwin TM. Brachial plexus palsy: An in utero injury? Am J Obstet Gynecol. 1999;180(5):1303–1307. doi: 10.1016/S0002-9378(99)70633-2
- Zafeiriou DI, Psychogiou K. Obstetrical brachial plexus palsy. Pediatr Neurol. 2008;38(4):235–242. doi: 10.1016/j.pediatrneurol.2007.09.013
- Report of the American College of Obstetricians and Gynecologists’ task force on neonatal brachial plexus palsy. Executive summary: neonatal brachial plexus palsy. Obstet Gynecol. 2014;123(4): 902–904. doi: 10.1097/01.AOG.0000445582.43112.9a
- Govindan M, Burrows HL. Neonatal brachial plexus injury. Pediatr Rev. 2019;40(9):494–496. doi: 10.1542/pir.2018-0113
- Gherman RB, Goodwin TM, Ouzounian JG, et al. Brachial plexus palsy associated with cesarean section: An in utero injury? Am J Obstet Gynecol. 1997;177(5):1162–1164. doi: 10.1016/S0002-9378(97)70034-6
- Alfonso I, Papazian O, Shuhaiber H, et al. Intrauterine shoulder weakness and obstetric brachial plexus palsy. Pediatr Neurol. 2004;31(3):225–227. doi: 10.1016/j.pediatrneurol.2004.02.010
- Alfonso I, Diaz-Arca G, Alfonso DT, et al. Fetal deformations: A risk factor for obstetrical brachial plexus palsy? Pediatr Neurol. 2006;35(4):246–249. doi: 10.1016/j.pediatrneurol.2006.03.011
- Tierney TS, Tierney BJ, Rosenberg AE, et al. Infantile myofibromatosis: a nontraumatic cause of neonatal brachial plexus palsy. Pediatr Neurol. 2008;39(4):276–278. doi: 10.1016/j.pediatrneurol.2008.06.009
- Torki M, Barton L, Miller DA, Ouzounian J.G. Severe brachial plexus palsy in women without shoulder dystocia. Obstet Gynecol. 2012;120(3):539–541. doi: 10.1097/AOG.0b013e318264f644
- Ouzounian JG. Risk factors for neonatal brachial plexus palsy. Semin Perinatol. 2014;38(4):219–221. doi: 10.1053/j.semperi.2014.04.008
- Levine MG, Holroyde J, Woods JR, et al. Birth trauma: Incidence and predisposing factors. Obstet Gynecol. 1984;63(6):792–795.
- Eng GD. Brachial plexus palsy in newborn infants. Pediatrics. 1971;48(1):18–28. doi: 10.1542/peds.48.1.18
- Ubachs JMH, Slooff ACJ, Peters LLH. Obstetric antecedents of surgically treated obstetric brachial plexus injuries. Br J Obstet Gynaecol. 1995;102(10):813–817. doi: 10.1111/j.1471-0528.1995.tb10848.x
- Gherman RB, Ouzounian JG, Satin AJ, et al. A comparison of shoulder dystocia-associated transient and permanent brachial plexus palsies. Obstet Gynecol. 2003;102(3):544–548. doi: 10.1097/00006250-200309000-00021
- Mollberg M, Lagerkvist A-L, Johansson U, et al. Comparison in obstetric management on infants with transient and persistent obstetric brachial plexus palsy. J Child Neurol. 2008;23(12):1424–1432. doi: 10.1177/0883073808320620
- Van der Looven R, Coupe AM. Constraint-induced movement therapy for children with neonatal brachial plexus palsy. Dev Med Child Neurol. 2021;63(5):495–495. doi: 10.1111/dmcn.14845
- Gordon M, Rich H, Deutschberger J, Green M. The immediate and long-term outcome of obstetric birth trauma. I. Brachial plexus paralysis. Am J Obstet Gynecol. 1973;117(1):51–56. doi: 10.1016/0002-9378(73)90727-8
- Nocon JJ, Mckenzie DK, Thomas LJ, Hansell RS. Shoulder dystocia: An analysis of risks and obstetric maneuvers. Am J Obstet Gynecol. 1993;168(6):1732–1739. doi: 10.1016/0002-9378(93)90684-B
- Chauhan SP, Rose CH, Gherman RB, et al. Brachial plexus injury: A 23-year experience from a tertiary center. Am J Obstet Gynceol. 2005;192(6):1795–1802. doi: 10.1016/j.ajog.2004.12.060
- Walsh JM, Kandamany N, Ni Shuibhne N, et al. Neonatal brachial plexus injury: comparison of incidence and antecedents between 2 decades. Am J Obstet Gynecol. 2011;204(4):324.e1–324.e6. doi: 10.1016/j.ajog.2011.01.020
- Grobman WA, Miller D, Burke C, et al. Outcomes associated with introduction of a shoulder dystocia protocol. Am J Obstet Gynecol. 2011;205(6):513–517. doi: 10.1016/j.ajog.2011.05.002
- Bager B. Perinatally acquired brachial plexus palsy — a persisting challenge. Acta Paediatrica. 1997;86(11):1214–1219. doi: 10.1111/j.1651-2227.1997.tb14849.x
- Van der Looven R, Le Roy L, Tanghe E, et al. Risk factors for neonatal brachial plexus palsy: a systematic review and metaanalysis. Dev Med Child Neurol. 2020;62(6):673–683. doi: 10.1111/dmcn.14381
- Coroneos CJ, Voineskos SH, Christakis MK, et al. Obstetrical brachial plexus injury (OBPI): Canada’s national clinical practice guideline. BMJ Open. 2017;7(1):e014141. doi: 10.1136/bmjopen-2016-014141
- Johnson GJ, Denning S, Clark SL, Davidson C. Pathophysiologic origins of brachial plexus injury. Obstet Gynecol. 2020;136(4): 725–730. doi: 10.1097/AOG. 0000000000004013
- Pulos N, Shaughnessy WJ, Spinner RJ, Shin AY. Brachial plexus birth injuries: A critical analysis review. JBJS Rev. 2021;9(6): e20.00004. doi: 10.2106/JBJS.RVW.20.00004
- Ratner AYu. Birth injuries of the spinal cord in children. Kazan: Kazan University Publishing House; 1978, 216 p. (In Russ.)
- Ministry of Health of the Republic of Kazakhstan. Traumas of peripheral nerves. Kazakhstan; 2017. (In Russ.)
- Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain. 1951;74(4):491–516. doi: 10.1093/brain/74.4.491
- Medical Research Counsil. Aids to the examination of the peripheral nervous system. Her Majesty’s Stationery Office. London; 1976. 70 p.
- Molnar GE. Brachial plexus injury in the newborn infant. Pediatr Rev. 1984;6(4):110–115. doi: 10.1542/pir.6.4.110
- Evans-Jones G, Kay SPJ, Weindling AM, et al. Congenital brachial palsy: incidence, causes, and outcome in the United Kingdom and Republic of Ireland. Arch Dis Childh. 2003;88(3):185–189. doi: 10.1136/fn.88.3.F185
- Eng GD, Binder H, Getson P, O’Donnell R. Obstetrical brachial plexus palsy (OBPP) outcome with conservative management. Muscle Nerve. 1996;19(7):884–891. doi: 10.1002/(SICI)1097-4598(199607)19:7<884::AID-MUS11>3.0.CO;2-J
- Yilmaz K, Caliskan M, Oge E, et al. Clinical assessment, MRI, and EMG in congenital brachial plexus palsy. Pediatr Neurol. 1999;21(4):705–710. doi: 10.1016/S0887-8994(99)00073-9
- Al-Rajeh S, Corea JR, Al-Sibai MH, et al. Congenital brachial palsy in the eastern province of Saudi Arabia. J Child Neurol. 1990;5(1): 35–38. doi: 10.1177/088307389000500108
- Jones HR Jr, Ryan MM. Radiculopathies and plexopathies. In: Darras BT, Jones HR Jr, Ryan MM, deVivo DC, editors. Neuromuscular disorders of infancy, childhood, and adolescence a clinician’s approach. 2nd edit. San Diego: Academic Press; 2015. P. 199–224. doi: 10.1016/B978-0-12-417044-5.00012-3
- Ford FR. Diseases of the nervous system in infancy, childhood, and adolescence. Arch Dis Child. 1960;35(184):628–629. doi: 10.1097/00007611-196009000-00037
- Daw E. Hyperextension of the head in breech presentation. Am J Obstet Gynecol. 1974;119(4):564–565. doi: 10.1016/0002-9378(74)90222-1
- Koshinski JL, Russo SA, Zlotolow DA. Brachial plexus birth injury: a review of neurology literature assessing variability and current recommendations. Pediatr Neurol. 2022;136:35–42. doi: 10.1016/j.pediatrneurol.2022.07.009
- Wall LB, Mills JK, Leveno K, et al. Incidence and prognosis of neonatal brachial plexus palsy with and without clavicle fractures. Obstet Gynecol. 2014;123(6):1288–1293. doi: 10.1097/AOG.0000000000000207
- Dubowitz LMS, Dubowitz V, Mercuri E. The neurological assessment of the pre-term and full-term infant. Clinics in developmental medicine. N148. London: MacKeith Press; 1999. 155 р.
- Palchik АB. Lectures on developmental neuroscience. Moscow: MEDPRESS-Inform; 2021. 472 p. (In Russ.)
- Саrbajal R, Paupe A, Hoenn E, et al. APN: evaluation behavioral scale of acute pain in newborn infants. Arch Pedaiatr. 1997;4(7): 623–628. doi: 10.1016/S0929-693X(97)83360-X
- Palchik АB, Bochkareva SA, Shabalov NP, et al. Pain in newborns and infants. Methodological recommendations of the Ministry of Health of the Russian Federation. Saint Petersburg; 2015. 27 p. (In Russ.)
- Kishkun AA. Laboratory studies in neonatology. Moscow: GEOTAR-Media; 2022. 592 p. (In Russ.)
- Francel PC, Koby M, Park TS, et al. Fast spin-echo magnetic resonance imaging for radiological assessment of neonatal brachial plexus injury. J Neurosurg. 1995;83(3):461–466. doi: 10.3171/jns.1995.83.3.0461
- Miller SF, Glasier CM, Griebel ML, Boop FA. Brachial plexopathy in infants after traumatic delivery: Evaluation with MR Imaging. Radiology. 1993;189(2):481–484. doi: 10.1148/radiology.189.2.8210376
- Tse R, Nixon JN, Iyer RS, et al. The diagnostic value of CT myelography, MR myelography, and both in neonatal brachial plexus palsy. AJNR Am J Neuroradiol. 2014;35(7):1425–1432. doi: 10.3174/ajnr.A3878
- Somashekar D, Yang LJ, Ibrahim M, Parmar HA. Highresolution MRI evaluation of neonatal brachial plexus palsy: A promising alternative to traditional CT myelography. AJNR Am J Neuroradiol. 2014;35(6):1209–1213. doi: 10.3174/ajnr.A3820
- Grahn P, Poyhia T, Sommarhem A, Nietosvaara Y. Clinical significance of cervical MRI in brachial plexus birth injury. Acta Orthop. 2019;90(2):111–118. doi: 10.1080/17453674.2018.1562621
- Smith BW, Chang KWC, Parmar HA, et al. MRI evaluation of nerve root avulsion in neonatal brachial plexus palsy: understanding the presence of isolated dorsal/ventral rootlet disruption. J Neurosurg Pediatr. 2021;27(5):589–593. doi: 10.3171/2020.9. PEDS20326
- Paradiso G, Granana N, Maza E. Prenatal brachial plexus paralysis. Neurology. 1997;49(1):261–262. doi: 10.1212/WNL.49.1.261
- Yang LJ-S. Neonatal brachial plexus palsy-management and prognostic factors. Semin Perinatol. 2014;38(4):222–234. doi: 10.1053/j.semperi.2014.04.009
- Soldado F, Fontecha CG, Marotta M, et al. The role of muscle imbalance in the pathogenesis of shoulder contracture after neonatal brachial plexus palsy: a study in a rat model. J Shoulder Elbow Surg. 2014;23(7):1003–1009. doi: 10.1016/j.jse.2013.09.031
- Kriukova IA, Khusainov NO, Baindurashvili AG, et al. Algorithm for treatment of children of first months of life with brachial plexus birth palsy. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(1):72–77. EDN: VTQYDL doi: 10.17816/PTORS4172-77
- Sundholm LK, Eliasson A-C, Forssberg H. Obstetric brachial plexus injuries: assessment protocol and functional outcome at age 5 years. Dev Med Child Neurol. 1998;40(1):4–11. doi: 10.1111/j.1469-8749.1998.tb15350.x
- 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):148–157. doi: 10.1111/j.1469-8749.2000.tb00062.x
- Noetzel MJ, Park TS, Robinson S, Kaufman B. Prospective study of recovery following neonatal brachial plexus injury. J Child Neurol. 2001;16(7):488–492. doi: 10.1177/088307380101600705
- Hoeksma AF, ter Steeg AM, Nelissen RG, et al. Neurological recovery in obstetric brachial plexus injuries: an historical cohort study. Dev Med Child Neurol. 2004;46(2):76–83. doi: 10.1111/j.1469-8749.2004.tb00455.x
- Smith NC, Rowan P, Benson LJ, et al. Neonatal brachial plexus palsy. Outcome of absent biceps function at three months of age. J Bone Joint Surg Am. 2004;86-A(10):2163–2170. doi: 10.2106/00004623-200410000-00006
- Grossman JA. Early operative intervention for selected cases of brachial plexus birth injury. Arch Neurol. 2006;63(7):1031–1032. doi: 10.1001/archneur.63.7.1031
- Strombeck C, Krumlinde-Sundholm L, Remahl S, Sejersen T. Long-term follow-up of children with obstetric brachial plexus palsy. I: functional aspects. Dev Med Child Neurol. 2007;49(3):198–203. doi: 10.1111/j.1469-8749.2007.00198.x
- Strombeck C, Remahl S, Krumlinde-Sundholm L, Sejersen T. Long-term follow-up of children with obstetric brachial plexus palsy. II: neurophysiological aspects. Dev Med Child Neurol. 2007;49(3): 204–209. doi: 10.1111/j.1469-8749.2007.00204.x
- Ali ZS, Bakar D, Li YR, et al. Utility of delayed surgical repair of neonatal brachial plexus palsy. J Neurosurg Pediatr. 2014;13(4): 462–470. doi: 10.3171/2013.12.PEDS13382
- Lagerkvist A-L, Johansson U, Johansson A, et al. Obstetric brachial plexus palsy: a prospective, population-based study of incidence, recovery, and residual impairment at 18 months of age. Dev Med Child Neurol. 2010;52(6):529–534. doi: 10.1111/j.1469-8749.2009.03479.x
- Bennett GC, Harrold AJ. Prognosis and early management of birth injuries to the brachial plexus. Brit Med J. 1976;1:1520. doi: 10.1136/bmj.1.6024.1520
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