Brachial plexus injury in the newborn.

Brachial plexus palsy in the neonate is classified according to the anatomic location and type of injury. Upper plexus lesions are observed most frequently. The overall rate of perinatal brachial plexus palsy (PBPP) has remained stable for the last 3 decades, although risk factors for the injury are well described. The true rate of full recovery after PBPP remains controversial. Knowledge of an infant’s PBPP classification can assist in predicting long-term outcome. A thorough physical examination is essential to make the diagnosis, evaluate for comorbidities, determine the treatment plan, and assess the need for referral. Additional investigations typically are not indicated. Initial management of the infant who has PBPP includes parent counseling, physical or occupational therapy, and clinical observation of the infant. A proportion of affected infants eventually requires surgical intervention or alternative therapeutic approaches, including botulinum toxin injections.