Unilateral diaphragmatic paralysis and Erb's palsy in the newborn.

Since Naunyn reported the first case of unilateral diaphragmatic paralysis in a newborn infant in 1902, 38 further cases have been described; 72% showed an association with Erb's palsy on the same side as the phrenic injury. As most cases have occurred after breech delivery, the majority of observers considered the injury to result from manipulations of the head and neck producing overstretching of the cervical nerves. Rupilius (1934), however, believed that malposition of the foetus in utero allowed compression of the brachial plexus and phrenic nerve between the clavicle, the first rib, and the transverse processes of the fifth and sixth cervical vertebrae. The present case showed avulsion of the anterior roots of the cervical nerves supplying the phrenic nerve on the affected side indicating that trauma by traction had occurred at birth.