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Zeng Y, Luo P, Zhao DR, Wang FY, Song B. Neonatal tachypnea caused by diaphragmatic paralysis: A case report. World J Clin Cases 2024; 12:5253-5257. [DOI: 10.12998/wjcc.v12.i22.5253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/23/2024] [Accepted: 06/04/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Diaphragmatic paralysis is typically associated with phrenic nerve injury. Neonatal diaphragmatic paralysis diagnosis is easily missed because its manifestations are variable and usually nonspecific.
CASE SUMMARY We report a 39-week-old newborn delivered via vaginal forceps who presented with tachypnea but without showing other birth-trauma-related manifestations. The infant was initially diagnosed with pneumonia. However, the newborn still exhibited tachypnea despite effective antibiotic treatment. Chest radiography revealed right diaphragmatic elevation. M-mode ultrasonography revealed decreased movement of the right diaphragm. The infant was subsequently diagnosed with diaphragmatic paralysis. After 4 weeks, tachypnea improved. Upon re-examination using M-mode ultrasonography, the difference in bilateral diaphragmatic muscle movement was smaller than before.
CONCLUSION Appropriate use of M-mode ultrasound to quantify diaphragmatic excursions could facilitate timely diagnosis and provide objective evaluation.
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Affiliation(s)
- Yan Zeng
- Department of Pediatrics, People's Hospital of Deyang City, Deyang 618000, Sichuan Province, China
| | - Pei Luo
- Department of Ultrasound, People's Hospital of Deyang City, Deyang 618000, Sichuan Province, China
| | - Di-Ran Zhao
- Department of Ultrasound, People's Hospital of Deyang City, Deyang 618000, Sichuan Province, China
| | - Feng-Yang Wang
- Department of Pediatrics, People's Hospital of Deyang City, Deyang 618000, Sichuan Province, China
| | - Bin Song
- Department of Nephrology, People's Hospital of Deyang City, Deyang 618000, Sichuan Province, China
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Najib KS, Razavinejad SM, Yarmahmoodi F, Barzegar H. Unilateral diaphragmatic paralysis and complete brachial plexus injury in a complex birth injury: A rare case report mimicking Tarlov cyst and review of literature. Clin Case Rep 2024; 12:e8406. [PMID: 38173882 PMCID: PMC10762482 DOI: 10.1002/ccr3.8406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 01/05/2024] Open
Abstract
The rare occurrence of Tarlov cysts in pediatric patients, particularly in the context of complex birth injuries, necessitates thorough evaluation and tailored management approaches. A comprehensive understanding of the clinical significance and optimal treatment strategies for this unique combination is crucial to ensure effective and individualized care for affected children.
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Affiliation(s)
| | | | - Fatemeh Yarmahmoodi
- Assistant Professor of Radiology, Medical Imaging Research CenterShiraz University of Medical SciencesShirazIran
| | - Hamide Barzegar
- Neonatal Research CenterShiraz University of Medical SciencesShirazIran
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Osorio M, Lewis S, Tse RW. Promoting Recovery Following Birth Brachial Plexus Palsy. Pediatr Clin North Am 2023; 70:517-529. [PMID: 37121640 DOI: 10.1016/j.pcl.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Neonatal brachial plexus palsies (NBPP) occur in 1.74 per 1000 live births with 20% to 30% having persistent deficits. Dysfunction can range from mild to severe and is correlated with the number of nerves involved and the degree of injury. In addition, there are several comorbidities and musculoskeletal sequelae that directly impact the overall functional development. This review addresses the nonsurgical and surgical management options and provides guidance for pediatricians on monitoring and when to refer for specialty care.
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Affiliation(s)
- Marisa Osorio
- Department of Rehabilitation Medicine, University of Washington, Seattle Children's Hospital, Rehabilitation Medicine, 4800 Sand Point Way Northeast, OB 8.410, Seattle, WA 98105, USA.
| | - Sarah Lewis
- Rehabilitation Medicine, Seattle Children's Hospital, 4800 Sand Point Way Northeast, OB 8.410, Seattle, WA 98105, USA
| | - Raymond W Tse
- Division of Plastic Surgery, Department of Surgery, University of Washington, 4800 Sand Point Way Northeast, OB9.527, Seattle, WA 98105, USA; Division of Craniofacial and Plastic Surgery, Department of Surgery, Seattle Children's Hospital, 4800 Sand Point Way Northeast, OB9.527, Seattle, WA 98105, USA
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Lewis SP, Sweeney JK. Comorbidities in Infants and Children with Neonatal Brachial Plexus Palsy: A Scoping Review to Inform Multisystem Screening. Phys Occup Ther Pediatr 2023; 43:503-527. [PMID: 36659827 DOI: 10.1080/01942638.2023.2169091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/31/2022] [Accepted: 01/04/2023] [Indexed: 01/21/2023]
Abstract
AIMS The scoping review was undertaken to explore comorbidities in infants and children with neonatal brachial plexus palsy (NBPP). The purpose of the review was to inform physical and occupational therapy screening of multiple body systems during the examination of children with NBPP. METHODS EBSCO Discovery and EMBASE electronic databases were searched for reports published between January 1996 and September 2021 describing comorbidities in children with NBPP between birth and 18 years. Key data pertaining to comorbidity prevalence, risk factors, clinical features, and associated outcomes were extracted and charted by one researcher and confirmed by a second researcher. RESULTS Thirty-six articles were included in the scoping review. Fourteen comorbidities were identified across the musculoskeletal, neurological, cardiopulmonary, and integumentary systems and the communication domain. The most prevalent comorbidities were clavicle fractures, plagiocephaly, torticollis, high body mass index, and language delays. The least prevalent comorbidity was facial nerve palsy. CONCLUSIONS Physical and occupational therapists can use knowledge of comorbidities in infants and children with NBPP for multisystem screening during the examination. A thorough history can identify risk factors for comorbidities. Detection of comorbidities during screening allows for timely specialty referrals to optimize care.
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Affiliation(s)
- Sarah P Lewis
- Rocky Mountain University of Health Professions, Provo, UT, USA
- Rehabilitation Department, Seattle Children's Hospital, Seattle, WA, USA
| | - Jane K Sweeney
- Rocky Mountain University of Health Professions, Provo, UT, USA
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Scholten AWJ, van Leuteren RW, de Jongh FH, van Kaam AH, Markhorst DG, Hutten J. Transcutaneous electromyography as a tool to assess recovery of hemidiaphragmatic paresis: A case report. J Neonatal Perinatal Med 2023; 16:725-729. [PMID: 38143382 DOI: 10.3233/npm-230110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
In this case report, we describe two repeated transcutaneous electromyography of the diaphragm (dEMG) measurements in an infant with suspected paresis of the right hemidiaphragm after cardiac surgery. The first measurement, performed at the time of diagnosis, showed a lower electrical activity of the right side of the diaphragm in comparison with the left side. The second measurement, performed after a period of expectative management, showed that electrical activity of the affected side had increased and was similar to the activity of the left diaphragm. This finding was accompanied by an improvement in the clinical condition. In conclusion, repeated measurement of diaphragmatic activity using transcutaneous dEMG enables the observation and quantification of spontaneous recovery over time. This information may assist the clinician in identifying patients not responding to expectative management and in determining the optimal timing of diaphragmatic surgery.
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Affiliation(s)
- A W J Scholten
- Department of Neonatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - R W van Leuteren
- Department of Neonatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - F H de Jongh
- Department of Neonatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - A H van Kaam
- Department of Neonatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - D G Markhorst
- Pediatric Intensive Care Unit, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J Hutten
- Department of Neonatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
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LoMauro A, Aliverti A, Perchiazzi G, Frykholm P. Physiological changes and compensatory mechanisms by the action of respiratory muscles in a porcine model of phrenic nerve injury. J Appl Physiol (1985) 2021; 130:813-826. [PMID: 33444121 DOI: 10.1152/japplphysiol.00781.2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Phrenic nerve damage may occur as a complication of specific surgical procedures, prolonged mechanical ventilation, or physical trauma. The consequent diaphragmatic paralysis or dysfunction can lead to major complications. The purpose of this study was to elucidate the role of the nondiaphragmatic respiratory muscles during partial or complete diaphragm paralysis induced by unilateral and bilateral phrenic nerve damage at different levels of ventilatory pressure support in an animal model. Ten pigs were instrumented, the phrenic nerve was exposed from the neck, and spontaneous respiration was preserved at three levels of pressure support, namely, high, low, and null, at baseline condition, after left phrenic nerve damage, and after bilateral phrenic nerve damage. Breathing pattern, thoracoabdominal volumes and asynchrony, and pressures were measured at each condition. Physiological breathing was predominantly diaphragmatic and homogeneously distributed between right and left sides. After unilateral damage, the paralyzed hemidiaphragm was passively dragged by the ipsilateral rib cage muscles and the contralateral hemidiaphragm. After bilateral damage, the drive to and the work of breathing of rib cage and abdominal muscles increased, to compensate for diaphragmatic paralysis, ensuing paradoxical thoracoabdominal breathing. Increasing level of pressure support ventilation replaces this muscle group compensation. When the diaphragm is paralyzed (unilaterally and/or bilaterally), there is a coordinated reorganization of nondiaphragmatic respiratory muscles as compensation that might be obscured by high level of pressure support ventilation. Noninvasive thoracoabdominal volume and asynchrony assessment could be useful in phrenic nerve-injured patients to estimate the extent and type of inspiratory muscle dysfunction.NEW & NOTEWORTHY This was the first (to our knowledge) implanted porcine model of phrenic nerve injury with a detailed multidimensional analysis of different degrees of diaphragmatic paralysis (unilateral and bilateral). Noninvasive thoracoabdominal volume and asynchrony assessment was shown to be useful in estimating the extent of diaphragmatic dysfunction and the consequent coordinated reorganization of nondiaphragmatic respiratory muscles. High level of pressure support ventilation was proved to obscure the interaction and compensation of respiratory muscles to deal with phrenic nerve injury.
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Affiliation(s)
- Antonella LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.,Section of Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Gaetano Perchiazzi
- Section of Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Peter Frykholm
- Section of Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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A Rare Case of Contralateral Diaphragm Paralysis following Birth Injury with Brachial Plexus Palsy: A Case Report and Review of the Literature. Case Rep Pediatr 2020; 2020:8844029. [PMID: 33274099 PMCID: PMC7676972 DOI: 10.1155/2020/8844029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/05/2020] [Accepted: 10/23/2020] [Indexed: 11/29/2022] Open
Abstract
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.
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