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Page 11 / Case 11.02

Weisman et al.1976
Review of literature: 71 cases of unilateral paralysis due to birth trauma, presenting in newborn period. The right side is affected 68% of the time and 56% are associated with Erb palsy. Fifty percent were diagnosed in the first 24 hours.

Aldric et al.,1980 J Peds.
He mentioned 10 cases of bilateral diphragmatic paralysis in newborns, which were reported in literature and 50% were related to birth trauma. The remainder were the results of malformation or were unknown. The outcome: 5/10 patients had plication, only one of them survived. The 4/5 patients who did not have plication, had improvement of diaphragmatic function with time.

Plication of diaphragm
It is indicated in severe respiratory distress and in inability to wean from a ventilator for over 2-6 weeks. It decreases the paradoxical motion of the affected side (Aldric et al.1980) and can increase the lung volume (Schonfeld et al.1980).

Tsugawa et al.1997
They reported 50 patients who had plication at ages 4 days-7 years. Twenty-five of them had phrenic nerve injury (PNI) and 25 had congenital muscular deficiency (CMD). Respiratory distress was the present in most patients. Ten of twenty-five patients with PNI were on ventilatory support. Four of the CMD patients required mechanical ventilatory support. In patients with PIN, ventilatory support was stopped within 0-6 days after plication. They concluded that symptomatic patients should be operated on immediately

PROGNOSIS

Recovery from diaphragmatic paralysis depends on the extent of the injury and the cause. With avulsion of the cervical roots from the cord, recovery is not possible. If the cause is tension or edema of the nerve, then recovery is likely. The time is variable. Function usually returns within 2 weeks, but resolution has been observed after more then 6 months. If it is unrecognized or inappropriately managed it can cause chronic hypoventilation, respiratory acidosis, nocturnal desaturation, and cor pulmonale.


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