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Case Report
Hemi-diaphragmatic paralysis
1 MD, Neonatology Fellow, Neonatal Intensive Care Unit, Pediatric Department at John H. Stroger Hospital of Cook County, 1969 W Ogden Ave, Chicago, IL 60612, USA
2 MD, Neonatology Attending, Neonatal Intensive Care Unit, Pediatric Department at John H. Stroger Hospital of Cook County, 1969 W Ogden Ave, Chicago, IL 60612, USA
3 MD, Pediatric Intensive Care Unit Fellow, PICU at Orlando Health Arnold Palmer Hospital for Children, Orlando Health, 92 W Miller St, Orlando, FL 32806, USA
4 PA-C, Neonatal Physician Assistant, Neonatal Intensive Care Unit, Pediatric Department at John H. Stroger Hospital of Cook County, 1969 W Ogden Ave, Chicago, IL 60612, USA
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Ugoeze Otome
Neonatology Fellow, Neonatal Intensive Care Unit, Pediatric Department at John H. Stroger Hospital of Cook County, 1969 W Ogden Ave, Chicago, IL 60612,
USA
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Article ID: 101428Z01UO2023
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Otome U, Castillo C, Soto-Ruiz A, Megchelsen R. Hemi-diaphragmatic paralysis. Int J Case Rep Images 2023;14(2):142–145.ABSTRACT
Introduction: Diaphragmatic paralysis (DP) involving the phrenic nerve is related to brachial plexus injury in 80–90% of the cases. Other causes include iatrogenic procedure involving the cardiopulmonary area. It causes respiratory distress which can be severe requiring prolonged need for respiratory support. Recovery can be spontaneous, typically by the first 6–12 months of life though some infants may require surgical intervention if no improvement in DP is noted by 1–2 months of life in the setting of compromised quality of life.
Case Report: We present a preterm infant, 31 completed weeks of gestational age, birth weight 1440 g born via emergency C-section due to preterm labor in breech presentation. During delivery, the patient suffered a left brachial plexus injury with phrenic nerve involvement. He developed respiratory distress requiring endotracheal intubation and mechanical ventilation. His clinical course involved multiple failed extubation attempts. Chest X-ray (CXR) and chest fluoroscopy confirmed the diagnosis of left hemi-diaphragmatic paralysis. The patient had a prolonged respiratory support course but was finally weaned to room air by three months of age.
Conclusion: Preterm infants can sustain perinatal brachial plexus injury like term or near-term infants in the setting of a traumatic birth irrespective of birth weight. The time and indications for conservative (non-surgical) versus surgical intervention remains debatable. Each case should be tailored to the child’s severity of injury and quality of life and growth. Clinical recovery can occur even with considerable persistence weakness on radiography or chest ultrasound.
Keywords: Diaphragmatic, Paralysis, Preterm
SUPPORTING INFORMATION
Author Contributions
Ugoeze Otome - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Christian Castillo - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Astrid Soto-Ruiz - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Rebecca Megchelsen - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Ugoeze Otome et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
