Neonatal Brachial Plexus Palsy in Children Aged 0 to 2.5 Years; Parent-Perceived Family Impact, Quality of Life, and Upper Extremity Functioning

Object Neonatal brachial plexus palsy (NBPP) represents a significant health problem with potentially devastating consequences. The most common form of NBPP involves the upper trunk roots. Currently, primary surgical repair is performed if clinical improvement is lacking. There has been increasing interest in “early” surgical repair of NBPPs, occurring within 3–6 months of life. However, early treatment recommendations ignore spontaneous recovery in cases of Erb's palsy. This study was undertaken to evaluate the optimal timing of surgical repair in this group with respect to quality of life. Methods The authors formulated a decision analytical model to compare 4 treatment strategies (no repair or repair at 3, 6, or 12 months of life) for infants with persistent NBPPs. The model derives data from a critical review of published studies and projects health-related quality of life and quality-adjusted life years over a lifetime. Results When evaluating the quality of life of infants with NBPP, improved outcomes are seen with delayed surgical repair at 12 months, compared with no repair or repair at early and intermediate time points, at 3 and 6 months, respectively. ANOVA showed that the differences among the 4 groups are highly significant (F = 8369; p < 0.0001). Pairwise post hoc comparisons revealed that there are highly significant differences between each pair of strategies (p < 0.0001). Meta-regression showed no evidence of improved outcomes with more recent treatment dates, compared with older ones, for either nonsurgical or for surgical treatment (p = 0.767 and p = 0.865, respectively). Conclusions These data support a delayed approach of primary surgical reconstruction to optimize quality of life. Early surgery for NBPPs may be an overly aggressive strategy for infants who would otherwise demonstrate spontaneous recovery of function by 12 months. A randomized, controlled trial would be necessary to fully elucidate the natural history of NBPP and determine the optimal time point for surgical intervention.

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Understanding Quality of Life and Patient Expectations Among Adolescents With Neonatal Brachial Plexus Palsy: A Qualitative and Quantitative Pilot Study

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2013.09.006 ◽

2013 ◽

Vol 38 (12) ◽

pp. 2387-2397.e2 ◽

Cited By ~ 25

Author(s):

Lee Squitieri ◽

Bradley P. Larson ◽

Kate W.-C. Chang ◽

Lynda J.-S. Yang ◽

Kevin C. Chung

Keyword(s):

Quality Of Life ◽

Pilot Study ◽

Brachial Plexus ◽

Patient Expectations ◽

Brachial Plexus Palsy ◽

Qualitative And Quantitative ◽

Neonatal Brachial Plexus Palsy

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QUALITY OF LIFE AND UPPER LIMB FUNCTION OF CHILDREN WITH NEONATAL BRACHIAL PLEXUS PALSY

Revista Paulista de Pediatria ◽

10.1590/1984-0462/2020/38/2018304 ◽

2020 ◽

Vol 38 ◽

Author(s):

Daiane Lazzeri de Medeiros ◽

Natália Borges Agostinho ◽

Luis Mochizuki ◽

Anamaria Siriani de Oliveira

Keyword(s):

Quality Of Life ◽

Brachial Plexus ◽

Upper Limb ◽

Outcome Data ◽

Emotional Impact ◽

Brachial Plexus Palsy ◽

Limb Function ◽

Upper Limb Function ◽

Neonatal Brachial Plexus Palsy

ABSTRACT Objective: To compare the upper limb function and quality of life between children with neonatal brachial plexus palsy and controls with unaffected brachial plexus (typical children). Methods: Twenty-four children with neonatal brachial plexus palsy and 24 typical ones were evaluated, both groups with 10±3 years of age. The upper limb function was assessed by the Modified Mallet Scale and the Active Movement Scale, whereas quality of life was analyzed by the Pediatric Outcome Data Collection Instrument and the Child Health Questionnaire. Mann-Whitney U tests investigated the differences between groups in such scales. Results: Children with neonatal brachial plexus palsy presented lower limb function compared to typical children in both scales. These children also presented lower scores for most of the Pediatric Outcome Data Collection Instrument domains, except for comfort/pain. In addition, they had lower scores in the following domains of the Child Health Questionnaire: physical functioning, pain, behavior, mental health, overall health perception, emotional impact on parents, and psychosocial summarized score. Conclusions: Neonatal brachial plexus palsy has a negative influence on upper limb function and quality of life, mainly considering overall health, basic mobility, physical and psychosocial functions, happiness, pain, behavior, mental health, upper limb function, and emotional impact on their parents.

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Health-Related Quality of Life Components in Children With Neonatal Brachial Plexus Palsy: A Qualitative Study

PM&R ◽

10.1016/j.pmrj.2016.08.002 ◽

2016 ◽

Vol 9 (4) ◽

pp. 383-391 ◽

Cited By ~ 4

Author(s):

Kate W.-C. Chang ◽

Amy Austin ◽

Jan Yeaman ◽

Lauren Phillips ◽

Anna Kratz ◽

...

Keyword(s):

Quality Of Life ◽

Qualitative Study ◽

Brachial Plexus ◽

Health Related Quality ◽

Brachial Plexus Palsy ◽

Neonatal Brachial Plexus Palsy ◽

Related Quality ◽

Health Related

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EVALUATION OF QUALITY OF LIFE IN BRACHIAL PLEXUS INJURY PATIENTS AFTER RECONSTRUCTIVE SURGERY

Hand Surgery ◽

10.1142/s0218810406003279 ◽

2006 ◽

Vol 11 (03) ◽

pp. 103-107 ◽

Cited By ~ 27

Author(s):

Izuru Kitajima ◽

Kazureru Doi ◽

Yasunori Hattori ◽

Semih Takka ◽

Emmanuel Estrella

Keyword(s):

Quality Of Life ◽

Brachial Plexus ◽

Upper Extremity ◽

Brachial Plexus Injury ◽

Short Form ◽

Bodily Pain ◽

Summary Score ◽

Joint Function ◽

Sf 36

To evaluate the subjective satisfaction of brachial plexus injury (BPI) patients after surgery based on the medical outcomes study 36-item short form health survey (SF-36) and to correlate their SF-36 scores with upper extremity functions. Four items were assessed statistically for 30 patients: SF-36 scores after BPI surgery were compared with Japanese standard scores; the correlation between SF-36 scores and objective joint functions; difference in SF-36 scores between each type of BPI; and influence of each joint function on the SF-36 scores. The SF-36 subscale: PF — physical functioning, RP — role-physical, BP — bodily pain, and the summary score PCS — physical component summary, were significantly inferior to the Japanese standard scores. SF-36 is more sensitive to shoulder joint function than to elbow and finger joint functions. Little correlation was found between SF-36 scores and objective evaluations of joint functions. Greater effort is needed to improve the quality of life (QOL) of BPI patients. This study showed that SF-36 is not sensitive enough to evaluate regional conditions. A region- or site-specific questionnaire is required to evaluate upper extremity surgery.

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A Systematic Review of the Electrodiagnostic Assessment of Neonatal Brachial Plexus Palsy

Neurology and Neurobiology ◽

10.31487/j.nnb.2020.02.12 ◽

2020 ◽

pp. 1-11

Author(s):

Anita Singh ◽

Sriram Balasubramanian ◽

Virginia Orozco

Keyword(s):

Brachial Plexus ◽

Obstetric Care ◽

Brachial Plexus Palsy ◽

Signal Shape ◽

Prognostic Information ◽

Functional Deficits ◽

Neonatal Brachial Plexus Palsy ◽

Demyelinating Lesions ◽

Multiple Levels

Despite improvements in obstetric care, neonatal brachial plexus palsy continues to significantly impact infants’ lives worldwide, with an incidence of 1 to 4 per 1000 live births. While a majority of affected infants recover spontaneously by three months, 20-30% suffer permanent functional deficits that significantly impair their quality of life. Anatomical complexity of the brachial plexus results in varying degrees of injury and pathological changes at multiple levels within the plexus. Current clinical diagnosis relies on electrodiagnostic techniques such as nerve conduction (i.e., motor and sensory) and electromyography studies. These techniques not only aid clinicians to differentiate between axonal and demyelinating lesions, evident by changes in signal shape and conduction, but also provide prognostic information in cases of brachial plexus injuries. The presented study offers a comprehensive review of existing literature on electrodiagnostic techniques employed for assessing neonatal brachial plexus injuries.

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