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Brachial Plexus Birth Injury (BPBI): A Review of Neurosurgery Literature Assessing Variability and Current Recommendations
Ryan A Hoffman, MD1; Christine Conroy, MD1; Lauren Jacobson, MD2; Stephanie A Russo, MD, PhD3; Dan A Zlotolow, MD?
1Einstein Healthcare Network, Philadelphia, PA; 2Washington University in St Louis, St Louis, MO; 3Akron Children's Hospital, Akron, OH; 4Shriners Hospital for Children Philadelphia, Philadelphia, PA

Introduction:
Brachial plexus birth injuries occur in approximately 1-4/1,000 live births. While there is an abundance of literature on BPBI, there is a lack of uniformity between specialties, leading to miscommunication amongst parents regarding management and referral. This study aimed to evaluate Neurosurgical publications for consistencies and discrepancies between available literature and current practices.
Material & Methods
Neurosurgery journals published between 1972 to 2019 were evaluated using Ovid Medline and PubMed. Each article was reviewed by one of the authors. Informative review and analysis were performed to identify relevant recommendations. After adequate screening, 44 articles were included.
Results:
Of the included articles, the most common specialty of the primary author was Neurosurgery, seen in 75% of articles. The most common disease names reported were Neonatal Brachial Plexus Palsy and Obstetrical Brachial Plexus Palsy both seen in 18/44 of the articles. 37 articles reported types/location of injuries including upper, middle, and lower plexus. The degree of injury (including but not limited to neurapraxia, avulsion and rupture) were reported in 30 articles. Only 27 mentioned primary causes of BPBI. Diagnostic studies were recommended in 52.3% of articles. Physical and/or occupational therapy was recommended in 47.7 % of articles. The most common indications for surgery were flail arms or lack of elbow flexion at 3 months. In terms of timing, the most common amount of time recommended prior to operative intervention was 6 months (5 articles). The average referral age in months was not mentioned in 32 articles, and articles that did mention average referral age had a wide range of timing (birth-27 months). Four articles stated patients were referred to multidisciplinary teams; two of these articles described the ideal multidisciplinary team. Four articles suggested referral to Neurosurgery.
Conclusions
Early referral to an experienced multidisciplinary care team is critical to optimize outcomes for children with BPBI. Our review of Neurosurgery literature demonstrated similar general information about BPBI such as incidence, risk factors, and spontaneous recovery rates; however, differences in diagnostic studies and management of patients were noted. Perhaps most notable was the lack of information regarding evaluation and treatment of glenohumeral dysplasia. While this was expected given that Neurosurgeons do not typically managing shoulder ailments, it is important for Neurosurgical literature to have easily accessible and clear recommendations. Our study highlights the importance of interdisciplinary collaboration and effective communication with BPBI patients. With these improvements, improved satisfaction and patient outcomes can be obtained.


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