Neonatal Brachial Plexus Injuries

November 12, 2020

Neonatal brachial plexus injuries can develop during childbirth, requiring treatment, which could include neurosurgery.

Congratulations!  You are having a baby! You are making plans and dreaming of all of the wonderful changes your bundle of joy will bring.  Creating a family is one of the most rewarding endeavors in our lives, and we prepare meticulously as we wait for the big day.  Unfortunately, however, childbirth is not always smooth, and unforeseen problems may arise.

It is sporadic for newborns to be injured during childbirth. However, each year during the delivery process, about one to three out of 1,000 babies sustain an injury to a network of nerves in their neck called the brachial plexus. The brachial plexus carries signals for feeling and movement from the spinal cord to the shoulder, arm, and hand. When those nerves are damaged, the function of the entire arm can be seriously impacted.

What is a Neonatal Brachial Plexus Injury?

Neonatal brachial plexus injury is an injury to the brachial plexus nerves. The nerves of the brachial plexus may be stretched, compressed, or torn in a difficult delivery. The result might be a loss of muscle function or even paralysis of the upper arm.

What Are the Types of Neonatal Brachial Plexus Injuries?

Brachial plexus birth injuries are often categorized according to the type of nerve injury and the pattern of nerves involved. There are four types of nerve injuries.

The most common form is a nerve that is stretched but not torn.  It is called neurapraxia and usually occurs outside of the spinal cord.  The newborn child’s affected nerves may recover on their own, usually within the first 2 weeks of life.

A bronchial plexus rupture is another kind of injury.  Here the nerve is torn, but not in the area attached to the spinal cord.  It is fairly common and may require surgical intervention once the child reaches 4 months of age.

A bronchial plexus avulsion occurs in approximately 10 to 20% of the cases. When the nerve roots are torn from the spinal cord itself, resulting in injury to the nerves that control the diaphragm, causing breathing difficulties. A droopy eyelid on the affected side and partial facial paralysis may indicate a more severe injury identified as Horner’s syndrome.  The damage cannot be surgically repaired directly; it must be replaced in the form of nerve transfers, requiring delicate neurosurgery.

The final kind of brachial plexus injury is a neuroma, which occurs when the nerve has tried to heal, but scar tissue has formed against the injured nerve, thereby causing interference with nerve function. It requires surgical treatment to reconstruct the nerve and/or secondary tendon transfers.

What Are the Causes of Neonatal Brachial Plexus?

The brachial plexus nerves can be affected by compression inside the mother’s womb or during a difficult delivery. Injury may be caused by:

  • The infant’s head and neck pulling toward the side as the shoulders pass through the birth canal
  • Stretching of the infant’s shoulders during a head-first delivery
  • Pressure on the baby’s raised arms during a breech (feet-first) delivery
  • Breech delivery complications
  • larger-than-average newborn (such as an infant of a diabetic mother)
  • Difficulty delivering the baby’s shoulder after the head has already come out (called shoulder dystocia)

How is a Neonatal Brachial Plexus Injury Diagnosed and Treated?


At birth, doctors will check for paralysis, numbness, position, and grip strength. They also will check a baby’s Moro reflex (startle response). This is when a baby throws out the arms and legs, then curls them in when startled. A specialist who treats infants with these injuries usually oversees the tests and treatments. The specialist might order x-rays, a CAT scan, or MRI, and possibly a series of nerve tests to determine the extent of the damage.


Most babies with a brachial plexus injury regain both movement and feeling in the affected arm. In mild cases, this might happen without treatment. Other babies might need daily physical therapy.  A physical therapist will teach parents exercises to do at home to help their baby get better.  There are also massage techniques that help.

For a more severe injury, a child will be cared for by a team of specialists such as neurosurgeons, orthopedic surgeons, and pediatric neurologists. If pain, weakness, or numbness continue, surgery often can help.

What If I Suspect Malpractice Is the Cause of My Baby’s Injury?

A doctor or other caregiver might be negligent in a brachial plexus injury if he or she used too much force on the baby during vaginal delivery.

It could also be considered negligence if a doctor should have noticed signs that labor would be complicated but failed to perform a Cesarean section to avoid those complications. Such as a mother with gestational diabetes, causing an unusually large baby. The use of instruments, like forceps, can also be considered malpractice if they caused an injury.

Any medical malpractice warrants a lawsuit against the responsible party, which may be an individual doctor or an entire hospital. If your child was injured because of actions taken or actions not taken by a doctor or other medical professional, it might be medical malpractice. The proof is required that the person or facility you are suing was given explicit responsibility for your and your child’s medical care, this person or institution made a medical error, such as failing to perform a Cesarean section, and any error that was made was the direct cause of your child’s condition.

A Successful Lawsuit Starts With A Great Lawyer

To file a lawsuit against a doctor or hospital, you believe caused your child’s injury can seem like a daunting task. A successful lawsuit can provide you with financial compensation that can cover things like medical bills, future medical and therapeutic expenses, travel expenses for treatment, lost wages, and pain and suffering.

It would help if you had a lawyer experienced in medical malpractice cases and birth injuries to file the lawsuit for you, gather evidence, make a strong case, and represent you in a settlement agreement or trial, depending on how the lawsuit ends.

It would help if you had a lawyer experienced in medical malpractice cases to file your lawsuit, gather evidence, make a strong case, and represent you in a settlement agreement or trial.  Your family deserves the absolute best legal representation.  Contact Chamlin, Uliano & Walsh at 732-440-3950. We look forward to being your attorneys to represent your family during this challenging time.