Scientific/Clinical Article| Volume 33, ISSUE 3, P281-287.e1, July 2020

Recommendations for management of neonatal brachial plexus palsy: Based on clinical review

Published:March 07, 2020DOI:


      • Brachial plexus clinics need to be multidisciplinary and include dedicated therapists with experience in the assessment of neonatal brachial plexus palsy (NBPP) and a surgeon with experience in microsurgical repair of NBPP.
      • Referral of infants with NBPP to brachial plexus clinic (BPC) should occur by one month of age.
      • Referrals should be triaged effectively so that all infants less than 3 months of age have at least one appointment before attending BPC to determine their diagnosis, the nature and extent of their injury and to implement appropriate assessment and management.
      • Screening for comorbidities such as hip dysplasia and plagiocephaly and implementing appropriate management should occur at these initial appointments before attending BPC.
      • Education of clinicians in maternity hospitals and the community are essential to ensure that infants and children with NBPP are referred in a timely manner and managed appropriately outside the clinic environment.


      Study Design

      Descriptive report.


      Neonatal brachial plexus palsy (NBPP) involves a partial or total injury of the nerves that originate from spinal roots C5-C8 and T1. The reported incidence of NBPP is between 0.38 and 5.1 in 1000 births.

      Purpose of the Study

      This study describes the management NBPP in the first 3 years of life and to develop an assessment framework for infants with NBPP and postoperative guidelines for those undergoing primary surgery.


      Retrospective medical record audit from 2012 to 2017.


      Of 187 children referred to brachial plexus clinic (BPC), 138 were new referrals and included in the audit. The average number of new referrals per annum was 37; average age at referral was 6.61 week; average age at first appointment was 16.9 weeks. Of the 138 infants, 104 were initially assessed by a physiotherapist before attending BPC. The most common comorbidity was plagiocephaly.


      From 2012 to 2017, birth location, birth facility, referral source, and time between referral and initial assessment have remained stable. The age at referral, age at which the child was first assessed, and the number of children who received services externally before attending the hospital all decreased. The number of children seen by a physiotherapist before attending BPC increased. An NBPP assessment framework, including critical time points for assessment, and postoperative guidelines for infants and children undergoing primary surgery were created.


      Early referral is essential for effective management of NBPP and ideally infants should be assessed and management implemented before 3 months of age.


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      JHT Read for Credit

      Quiz: # 687

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • # 1.
        The incidence of NBPP has been reported to be up to approximately of newborns
        • a.
        • b.
        • c.
        • d.
      • # 2.
        Results were obtained through
        • a.
          videography of patients
        • b.
          interviews with parents
        • c.
          a customized, modified DASH for children
        • d.
          retrospective chart reviews
      • # 3.
        The study design is
        • a.
        • b.
        • c.
          an introductory descriptive report
        • d.
          a prospective cohort
      • # 4.
        The authors present
        • a.
          a diagnostic algorithm
        • b.
          an assessment framework and post op guidelines
        • c.
          ADL recommendations
        • d.
          a case report to support their results
      • # 5.
        Presentations of NBPP are sufficiently similar between infants to allow standardized management protocols
        • a.
          not true
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.

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