Thursday, April 24, 2014
Newborn and Infant Care
Infant arm nerve injury during delivery
My sister`s delivered a 10lb 13oz baby boy. She had a very hard delivery, vaginally. She and the Doctor did not know the baby was so big. The baby was trapped in the birth canal with the head out but the shoulders stuck. The doctor tried to break the collar bone to get him out, but the collar bone would not break. THe baby was finally delivered but has absolutely no use of the arm and when you pinch his arm he does not seem to feel it. What can we do and are there any articles about this type of injury? What is the name of the nerve that is in the arm/shoulder?
The common name for injuries suffered as a result of trauma during birth is peripheral nerve injuries; they result from stretching, compression, twisting, hyperextension, or separation of nerve tissue. The damage can range from swelling of the nerve to complete peripheral degeneration with later total recovery to complete division of all structures. The more common sites affected are the brachial plexus and the facial, phrenic, radial, median, and sciatic nerves. This type of injury is seen most often in term or large for gestational age infants.
Based upon your description, the injury appears to be a brachial plexus injury, which results from excessive lateral flexion, rotation, or traction on the neck. However, I can not determine which type or the degree of involvement from the description. Thus I will provide information about the most basic types.
In mild-to-moderate injuries of this type, the nerve sheaths remain intact, so full recovery is possible; recovery generally is within 2-3 months. More severe injuries that result in tearing of the nerve do not recover spontaneously.
The injuries are classified according to the location of the injury. The three major types are: Erb-Duchenne palsy (85-90%), Klumpke`s palsy (1 to 3%), and Erb-Duchenne-Klumpke palsy (7 to 9%).
Erb Duchenne palsy results from injury to the C5 and C6 nerve roots. The shoulder and upper arm are involved with denervation of the deltoid, supraspinous, biceps, and brachioradialis occurs. The arm lies passively at the infant`s side, abducted, and internally rotated, and the forearm is pronated. (This is often referred to as the "waiter`s tip" position.)
Klumpke`s palsy involves the C8 to T1 roots, affecting the lower arm and hand, and denervation of the intrinsic muscles of the hand and flexors of the wrist and fingers exist. Sweating and sensation may be absent in the affected hand and arm. The baby holds the arm at the side of the thorax in a clawhand posture. Moro and grasp reflexes are absent.
Erb-Duchenne-Klumpke palsy involves the entire arm and hand, due to injury of the nerve roots of the brachial plexus from C5 to T1. This form of paralysis involves all of the nerve fibers and complete paralysis of the upper and lower arm and hand and the arm is flaccid.
Prognosis depends upon the level and severity of the injury. About 80 to 90% of infants recover by age 3 to 6 months with supportive care. Some recovery is usually seen by two to three weeks. Lack of some recovery by 3 months is associated with a high incidence of residual damage.
Please discuss the specific type of injury with the baby`s pediatrician or nurse practitioner. Good luck for the baby`s full recovery.
Judy Wright Lott, RNC, NNP, DSN
Associate Professor of Nursing
College of Nursing
University of Cincinnati