Utility of delayed surgical repair of neonatal brachial plexus palsy

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

Pediatric Neurology ◽

10.1016/j.pediatrneurol.2016.06.015 ◽

2016 ◽

Vol 62 ◽

pp. 34-42 ◽

Cited By ~ 1

Author(s):

Menno van der Holst ◽

Duco Steenbeek ◽

Willem Pondaag ◽

Rob G.H.H. Nelissen ◽

Thea P.M. Vliet Vlieland

Keyword(s):

Quality Of Life ◽

Brachial Plexus ◽

Upper Extremity ◽

Family Impact ◽

Brachial Plexus Palsy ◽

Neonatal Brachial Plexus Palsy

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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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Surgical repair of aortic coarctation in adults: half a century of a single centre clinical experience

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz259 ◽

2019 ◽

Vol 56 (6) ◽

pp. 1178-1185 ◽

Cited By ~ 4

Author(s):

Djamila Abjigitova ◽

Mostafa M Mokhles ◽

Maarten Witsenburg ◽

Pieter C van de Woestijne ◽

Jos A Bekkers ◽

...

Keyword(s):

Quality Of Life ◽

Surgical Repair ◽

Coarctation Of The Aorta ◽

Surgical Reconstruction ◽

Refractory Hypertension ◽

Tertiary Referral Centre ◽

Related Quality ◽

Hospital Morbidity

Abstract OBJECTIVES Coarctation of the aorta (CoA) is rarely diagnosed and treated in adults and nowadays mostly treated with percutaneous techniques. The objective of this study is to report the long-term outcomes and health-related quality of life in a unique cohort of patients treated with an open surgical repair for their primary adult CoA. METHODS Ninety adult patients underwent primary surgical repair of CoA at our tertiary referral centre between 1961 and 2008 when the treatment strategy for adult CoA was exclusively surgical. RESULTS The median age at surgery was 24 years (interquartile range 20–36 years), and 39 patients (43%) were asymptomatic at presentation. CoA was located paraductally in most patients (64%), and bicuspid aortic valve was present in 39 (43%) patients. Surgical reconstruction of CoA with an end-to-end anastomosis was performed in majority of the patients (57%). Overall, in-hospital mortality occurred in 1 patient (1%). There was no in-hospital stroke, spinal cord ischaemia, renal replacement therapy or respiratory failure. The cumulative survival was 97.7%, 89.5%, 82.6%, 70.9% and 61.4% at 10, 20, 30, 40 and 50 years, respectively. Thirty-one patients (34%) required an additional cardiac surgery during follow-up. The majority of patients (77%) suffered from refractory hypertension even after decades of surgery. Compared with the matched Dutch population, patients reported a lower social functioning, mental health, vitality and general health with a higher body pain. CONCLUSIONS Patients with native adult CoA have low in-hospital morbidity and mortality when treated with an open surgical reconstruction. However, refractory hypertension and impaired quality of life remain important challenges during follow-up.

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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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Neonatal Brachial Plexus Palsy

10.1093/med/9780190617127.003.0023 ◽

2018 ◽

Author(s):

Raymond Tse ◽

Angelo B. Lipira

Keyword(s):

Brachial Plexus ◽

Multiple Root ◽

Surgical Reconstruction ◽

Delayed Presentation ◽

Brachial Plexus Palsy ◽

Nerve Reconstruction ◽

Nerve Transfers ◽

Neonatal Brachial Plexus Palsy ◽

Severity Of Injury ◽

Technical Details

Neonatal brachial plexus palsy occurs in approximately 1 in 1000 live births. The extent of involvement and severity of injury are variable. The chapter discusses assessment, nonsurgical treatment, and surgical treatment of neonatal brachial plexus palsy. The approach to surgical exploration is detailed and a number of scenarios are presented so that the principles of primary nerve reconstruction (including nerve graft and nerve transfers) can be illustrated. The scenarios include upper plexus injury, pan-plexus injury, multiple root avulsions, isolated deficits, delayed presentation, and failed reconstruction. Technical details of nerve grafting and nerve transfers are described. Secondary musculoskeletal consequences of brachial plexus palsy are also discussed, including strategies for prevention and options for secondary surgical reconstruction.

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FUNCTIONAL OUTCOME OF BRACHIAL PLEXUS RECONSTRUCTION AFTER TRAUMA

Neurosurgery ◽

10.1227/01.neu.0000303197.87672.31 ◽

2007 ◽

Vol 61 (5) ◽

pp. 1016-1023 ◽

Cited By ~ 55

Author(s):

Mohamed Ahmed-Labib ◽

Jeff D. Golan ◽

Line Jacques

Keyword(s):

Quality Of Life ◽

Brachial Plexus ◽

Functional Outcome ◽

Surgical Repair ◽

Short Form ◽

Consecutive Series ◽

Root Avulsion ◽

Short Form 36 ◽

The Mean

Abstract OBJECTIVE Traumatic brachial plexopathies can be devastating injuries. In addition to motor and sensory deficits, pain and functional limitations can be equally debilitating. We sought to evaluate functional outcome and quality of life using statistically validated tools. METHODS The authors identified a consecutive series of patients who underwent surgical repair of a brachial plexus injury by the same surgeon between 1997 and 2004 at the McGill University Health Center. Participating patients were sent a package containing the Short Form 36, the Disability of the Arm, Shoulder, and Hand questionnaire, a pain visual analog scale, and an additional question on their satisfaction with the surgery. Data was recorded and analyzed using statistical software (SPSS version 13.0 for Windows; SPSS, Inc., Chicago, IL). RESULTS Thirty-one patients with a mean age of 32.7 years at the time of injury participated in this study. The mean time to surgery was 7.5 months, and the mean follow-up period was 42.7 months. Patients who underwent surgery within 6 months of injury scored consistently better on the Disability of the Arm, Shoulder, and Hand questionnaire (P = 0.03) and the Short Form 36 subscale scores. There was no difference between supra- and infraclavicular injuries; however, patients with root avulsion injuries were more likely to have pain (P = 0.04) and scored lower on the Disability of the Arm, Shoulder, and Hand questionnaire (P = 0.05). CONCLUSION Statistically validated tools can be used to evaluate the quality of life, upper extremity function, and pain after brachial plexus repairs. Root avulsion injuries and delayed surgical repair correlated negatively with functional outcomes.

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