Neonatal brachial plexus injury presents as weakness or paralysis of the upper extremity or extremities at birth, most often related to stretching of the brachial plexus in the perinatal period. Early recognition and management in the newborn period can significantly impact outcomes. Therefore, it is important for pediatricians to be knowledgeable regarding the clinical spectrum of injury, prognosis, and treatment options.

The incidence of brachial plexus injury ranges from 0.4 to 4 per 1,000 births. The primary risk factors are shoulder dystocia and macrosomia (birthweight >4,000 g). Other risk factors include maternal diabetes or obesity, prolonged labor, and delivery with forceps or a vacuum extractor. Although cesarean delivery decreases the risk of brachial plexus injury, it does not eliminate it, and it carries other risks for both mother and infant.

The brachial plexus is composed of nerve roots C5 through T1 and can be divided into the upper (C5 and...

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