A Rare Case of Contralateral Diaphragm Paralysis following Birth Injury with Brachial Plexus Palsy: A Case Report and Review of the Literature
Clinical History. A 4.4 kg male was born to a 25-year-old, G2P1, nondiabetic woman at 39 and 5/7 weeks. Delivery was complicated by shoulder dystocia requiring forceps-assisted vaginal delivery, resulting in left arm Erb’s palsy secondary to left brachial plexus injury. He was born with low muscle t...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Case Reports in Pediatrics |
| Online Access: | http://dx.doi.org/10.1155/2020/8844029 |
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| author | Audra J. Reiter Yazan K. Rizeq Benjamin T. Many Jonathan C. Vacek Fizan Abdullah Seth D. Goldstein |
| author_facet | Audra J. Reiter Yazan K. Rizeq Benjamin T. Many Jonathan C. Vacek Fizan Abdullah Seth D. Goldstein |
| author_sort | Audra J. Reiter |
| collection | DOAJ |
| description | Clinical History. A 4.4 kg male was born to a 25-year-old, G2P1, nondiabetic woman at 39 and 5/7 weeks. Delivery was complicated by shoulder dystocia requiring forceps-assisted vaginal delivery, resulting in left arm Erb’s palsy secondary to left brachial plexus injury. He was born with low muscle tone and bradycardia and subsequently required intubation for poor respiratory effort. He was extubated on day one of life but continued to be tachypneic and have borderline oxygen saturation, requiring intensive care. Chest radiographs demonstrated a progressive clearing of his lung fields, consistent with presumptively diagnosed meconium aspiration. However, a persistent elevation of the right hemidiaphragm was noted, and his tachypnea and increased work of breathing continued. Focused ultrasound of the diaphragm was performed, confirming decreased motion of the right hemidiaphragm. Following a multidisciplinary discussion, thoracoscopic right diaphragm plication was performed on the 33rd day of life. He was extubated postoperatively and subsequently weaned to room air with a notable decrease in tachypnea over 48 hours. He was discharged on postoperative day 12 and continues to thrive at 6 months of age without respiratory embarrassment. Purpose. Ipsilateral phrenic nerve injury with diaphragm paralysis from shoulder dystocia during vaginal delivery is a recognized phenomenon. Herein, we present a case of contralateral diaphragm paralysis in order to draw attention to the clinician that this discordance is possible. Key Points. According to Raimbault et al., clinical management of newborns who experience birth injury is a multidisciplinary effort. According to Fitting and Grassino, though most cases of phrenic nerve injuries are ipsilateral to shoulder dystocia brachial plexus palsy, contralateral occurrence is possible and should be considered. According to Waters, diaphragm plication is a safe and effective operation. |
| format | Article |
| id | doaj-art-bd88d1192e2c49d1bbef8b3fc16b95f4 |
| institution | DOAJ |
| issn | 2090-6803 2090-6811 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Pediatrics |
| spelling | doaj-art-bd88d1192e2c49d1bbef8b3fc16b95f42025-08-20T03:23:34ZengWileyCase Reports in Pediatrics2090-68032090-68112020-01-01202010.1155/2020/88440298844029A Rare Case of Contralateral Diaphragm Paralysis following Birth Injury with Brachial Plexus Palsy: A Case Report and Review of the LiteratureAudra J. Reiter0Yazan K. Rizeq1Benjamin T. Many2Jonathan C. Vacek3Fizan Abdullah4Seth D. Goldstein5Ann and Robert H. Lurie Children’s Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USAAnn and Robert H. Lurie Children’s Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USAAnn and Robert H. Lurie Children’s Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USAAnn and Robert H. Lurie Children’s Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USAAnn and Robert H. Lurie Children’s Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USAAnn and Robert H. Lurie Children’s Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USAClinical History. A 4.4 kg male was born to a 25-year-old, G2P1, nondiabetic woman at 39 and 5/7 weeks. Delivery was complicated by shoulder dystocia requiring forceps-assisted vaginal delivery, resulting in left arm Erb’s palsy secondary to left brachial plexus injury. He was born with low muscle tone and bradycardia and subsequently required intubation for poor respiratory effort. He was extubated on day one of life but continued to be tachypneic and have borderline oxygen saturation, requiring intensive care. Chest radiographs demonstrated a progressive clearing of his lung fields, consistent with presumptively diagnosed meconium aspiration. However, a persistent elevation of the right hemidiaphragm was noted, and his tachypnea and increased work of breathing continued. Focused ultrasound of the diaphragm was performed, confirming decreased motion of the right hemidiaphragm. Following a multidisciplinary discussion, thoracoscopic right diaphragm plication was performed on the 33rd day of life. He was extubated postoperatively and subsequently weaned to room air with a notable decrease in tachypnea over 48 hours. He was discharged on postoperative day 12 and continues to thrive at 6 months of age without respiratory embarrassment. Purpose. Ipsilateral phrenic nerve injury with diaphragm paralysis from shoulder dystocia during vaginal delivery is a recognized phenomenon. Herein, we present a case of contralateral diaphragm paralysis in order to draw attention to the clinician that this discordance is possible. Key Points. According to Raimbault et al., clinical management of newborns who experience birth injury is a multidisciplinary effort. According to Fitting and Grassino, though most cases of phrenic nerve injuries are ipsilateral to shoulder dystocia brachial plexus palsy, contralateral occurrence is possible and should be considered. According to Waters, diaphragm plication is a safe and effective operation.http://dx.doi.org/10.1155/2020/8844029 |
| spellingShingle | Audra J. Reiter Yazan K. Rizeq Benjamin T. Many Jonathan C. Vacek Fizan Abdullah Seth D. Goldstein A Rare Case of Contralateral Diaphragm Paralysis following Birth Injury with Brachial Plexus Palsy: A Case Report and Review of the Literature Case Reports in Pediatrics |
| title | A Rare Case of Contralateral Diaphragm Paralysis following Birth Injury with Brachial Plexus Palsy: A Case Report and Review of the Literature |
| title_full | A Rare Case of Contralateral Diaphragm Paralysis following Birth Injury with Brachial Plexus Palsy: A Case Report and Review of the Literature |
| title_fullStr | A Rare Case of Contralateral Diaphragm Paralysis following Birth Injury with Brachial Plexus Palsy: A Case Report and Review of the Literature |
| title_full_unstemmed | A Rare Case of Contralateral Diaphragm Paralysis following Birth Injury with Brachial Plexus Palsy: A Case Report and Review of the Literature |
| title_short | A Rare Case of Contralateral Diaphragm Paralysis following Birth Injury with Brachial Plexus Palsy: A Case Report and Review of the Literature |
| title_sort | rare case of contralateral diaphragm paralysis following birth injury with brachial plexus palsy a case report and review of the literature |
| url | http://dx.doi.org/10.1155/2020/8844029 |
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