Two cases of unilateral paralysis of the diaphragm in the newborn treated surgically.

Unilateral paralysis of the diaphragm in the newborn infant is not a common condition. It does not appear to be well known in this country, for there have been no reports of the condition in the British literature. It is, however, a serious condition, and is often fatal because of respiratory difficulty and, to a lesser extent, of the feeding difficulties always associated with dyspnoea in infants. This contrasts riarkedly with the absence of any such respiratory difficulty from diaphragmatic-paralysis in adult life or later in childhood and is due to the very mobile mediastinum of the infant becoming markedly displaced, so that, in addition to the lung on the side of the paralysed diaphragm being compressed, the lung on the opposite side also becomes compressed. This is clearly seen in Figs. 1A and 4A. The condition has been reported most often on the right side. It may be associated with a brachial plexus injury of the Erb type or it may be an isolated lesion. Schifrin, writing in 1952, was able to collect from the literature nine cases of isolated paralysis of the diaphragm in the newborn, all from American and German sources, and he added two further cases. The following two cases of isolated diaphragmatic paralysis are, therefore, the twelfth and thirteenth to be reported. Incidentally, none of the previously reported cases have been treated surgically, nor, even when ending fatally, does operation appear to have been considered.