Obstetrical Brachial Plexus Palsy: Outcome with Conservative Managementand Factors Effecting the Prognosis

Abstract

lnspite of advances in obstetrical technology, brachial plexus birth palsy still occursin about 0.5- 2.6 in every 1000 live births. Recently, succesful results of early surgical intervention have been reported by advanced methods of microsurgery in selected infants. in most of the studies early surgical repair is recommended in infants who do not show any development at the end of the third month. Selection criteria, the time and the methodology of neurosurgery vary in different centers.in infants with obstetrical brachial plexus palsy we aimed to evaluate the outcome of conservative therapy, actors effecting the prognosis and selection criteria for infants who will benefit from early surgical intervention. in our study including 20 neonates with brachial plexus palsy the injury was proximal in 70% and total in 30%. After fourth months of conservative therapy, total recovery was significantly higher in the proximally affected group (71.4%) as compared to the totaly affected group ( 16.7%), (p=0.03). in proximal brachial plexus palsy group total recovery was 100% in neonates with no or partial denervation group but 20% in neonates with profound denervation found in electromyographic studies (p=0.03). We can conclude that birth weight, the effected extremity, presence of associated birth trauma had no prognostic effect but the initial level of the truncus injury and the degree of the damage evaluated by the physical and electromyographic examinations were the factors effecting the prognosis.