Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, Michigan 48109-5338, USA.
Pediatr Neurol. 2010 Mar;42(3):234-6. doi: 10.1016/j.pediatrneurol.2009.11.005.
Phrenic nerve palsy can occur in the context of neonatal brachial plexus palsy, yet neither outcomes nor definitive treatment guidelines have been established. Diaphragmatic paralysis alone in the newborn results in significant respiratory sequelae and failure to thrive. Reviewing the available literature revealed little information about the incidence of phrenic nerve palsy associated with neonatal brachial plexus palsy, or whether outcomes are associated with the severity of the brachial plexus palsy. Of patients with brachial plexus palsy evaluated during 2005-2009 (n = 166) at our institution, a minority (2.4%; n = 4) had clinically significant diaphragmatic palsy. Of these, a majority (75%; n = 3) manifested respiratory complications sufficient to warrant diaphragmatic plication. The severity of brachial plexus palsy failed to correlate with severity of respiratory consequences. None of the patients underwent nerve repair or reconstruction. We suggest that diaphragmatic paralysis should not be overlooked during a brachial plexus examination, and diaphragmatic paralysis in the very young may require aggressive intervention before the treatment of brachial plexus palsy.
膈神经麻痹可发生在新生儿臂丛神经麻痹的情况下，但尚未确定其结局和明确的治疗指南。新生儿单纯性膈肌麻痹会导致严重的呼吸后遗症和生长发育不良。回顾现有文献，关于与新生儿臂丛神经麻痹相关的膈神经麻痹的发生率，或者结局是否与臂丛神经麻痹的严重程度相关，几乎没有信息。在我们机构，2005-2009 年间对 166 例臂丛神经麻痹患者进行评估，其中少数（2.4%；n=4）存在临床显著的膈神经麻痹。其中，大多数（75%；n=3）表现出足够引起膈肌切开术的呼吸并发症。臂丛神经麻痹的严重程度与呼吸后果的严重程度无关。这些患者均未进行神经修复或重建。我们建议，在进行臂丛神经检查时不应忽视膈神经麻痹，而非常年幼的膈神经麻痹可能需要在治疗臂丛神经麻痹之前积极干预。
