Early surgical intervention for diaphragmatic paralysis in a neonate; report of a case and literature review.
BACKGROUND
Diaphragmatic paralysis in newborns is related to brachial plexus palsy. It can cause respiratory failure necessitating prolonged mechanical ventilation and subsequent extubation failure.


METHODS
We present a two-hour-old male newborn with a birth weight of 4500 grams who had a right-sided brachial plexus palsy and right diaphragmatic paralysis due to shoulder dystocia. He developed respiratory distress due to isolated paralysis of the right hemi diaphragm. The clinical course was progressive, his condition worsening despite oxygen application. Physical examination, chest X-rays and M-mode ultrasonography of the diaphragm confirmed the diagnosis diaphragmatic paralysis. Surgical plication of diaphragm was done earlier than the usual time because of recurrent extubation failure. Diaphragmatic plication led to rapid improvement of pulmonary function and allowed discontinuation of mechanical ventilation in less than 3 days.


CONCLUSIONS
Early diaphragmatic plication enhances weaning process and may prevent or minimize the morbidity associated with long-term mechanical ventilation in a neonate with diaphragmatic paralysis.
Department of Pediatrics, Non-Communicable Pediatric Disease Research Center, Amirkola Children's Hospital, Babol University of Medical Sciences, Babol, Iran.
Mousa
M
Ahmadpour-Kacho
Yadollah
Y
Zahedpasha
Abbas
A
Hadipoor
Zahra
Z
Akbarian-Rad