United Brachial Plexus Network, Inc.

The most respected text on pediatric neurology,Neurology of the Newborn by Volpe has an extensive discussion of diaphragmatic paralysis. Vople says that diaphragmatic paralysis in a child with a brachial plexus injury is evidence of "extreme lateral traction" in the delivery.Diaphragmatic paralysis is only present in a small percentage of brachial plexus cases, but when it does occur it as close to absolute evidence of extreme traction, and medical negligence as we have. If anyone wants a more complete reference to Volpe please contact me or post a note.

Ken Levine
www.Klevinelaw.com
Klevine@Klevinelaw.com
617-566-2700

That is very interesting Ken, something that although our lawsuit is settled for years now, probably would have alleviated the defense's cause of the Brachial plexus Injury to be "IN VITRO" since my son's diaphram was also parylized but has since gotten so much better !!! THANKS GAYLE

From an anatomy standpoint, this makes perfect sense. The phrenic nerve is not as vulnerable as the plexus, starting at C5. Therefore, if C4 is damaged, it stands to reason that it would take a greater force and angle to do so.

So sad. I will remember until the day I die watching our midwife jerk Aria in all directions, trying to free her from a shoulder dystocia. I remember thinking, "God, please don't let her rip Aria in half."

This injury is so maddening, and so unnecessary.

BUMPING UP for KarenW3.

Carolyn J

Hi, my son also had an injured diaphram. They found it when he was about 9 months old. He developed pneumonia, and when his pediatrician was listening to his lungs, she said that his left lung was not inflating properly, and ordered a special x-ray, called a flouriscopy. (not sure if I spelled that right, sorry!) Anyway, it showed that his left lung was collapsed, so he was put into the hospital asap. After his pneumonia cleared up, we saw a specialist at Emmanual Hospital in Portland, OR (Dr. Thomas Curran who was an awesome surgeon) who said that he needed a diaphram plication. That is where they sew down the diaphram. His was not working properly (it should go up and down). His was going side-to-side, like a windshield wiper. He had the surgery at 10 months, and has not had any problems since then. I used to worry, but he seems ok. He is 8 years old now. I don't think a regular x-ray would show this as well as the flouriscopy x-ray does. Definately get some different opinions, or at least the flouriscopy x-ray.

My daughter had C4 rupture that was not detected right away. As an infant, she would breathe rapidly and very shallow. She couldn't suck well. She lost weight. She would throw up after nursing. I just kept taking her to the Dr and he put down "failure to thrive". Finally we got an X-ray which showed that her heart had shifted way over to the left. Then we got the fluoroscopy done which proved right diaphragm paralysis. She was losing wieght because she had to use so much energy just to breathe. The heart shift was because the right lung was always "up" (no diaphragm muscle to pull it down) so it pushed the heart over. She was throwing up due to the lung elevation, her stomach also came up higher in her chest. She was put on oxygen 24/7 to aid her breathing. Carrying her around with the tank and the nasal canulas (sp?) was so sad. Finally we got into to see a surgeon. He took one look at her and told us to go straight to the ER. We stayed for two weeks to get her stable enough for the diaphragm plication. Her O2 sat levels were way off and she had lost so much weight. She had it done when she was 8 weeks old. Her breathing improved because now the lung has room to passively inflate. We didn't have any follow up with the pulmonology Dr. to know what issues may come up or if we needed to do anything "special". Now she is 6. We haven't experienced any limits so far. She had 3 more surgeries after that for BPI and I always tell the anesthesiologist.