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.
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.
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).
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