In half of these there was delayed recovery, in which case complete neurological recovery was assessed from 1.5 to 16 months of age (median age 6.5 months, SD 4.2 months). Neurological outcome was not as favourable as is often reported: complete neurological recovery occurred in 37 out of 56 children (66%). They underwent a final neurological examination at a mean age of 3 years 10 months (range 1 to 7 years). All children (n=56 31 females, 25 males) with OBPI were evaluated at fixed time intervals by one examiner. After reconstruction of brachial plexus, the child needs a comprehensive therapy program, which involves passive stretching, sensory stimulation, exercises to promote the development of active voluntary movements, bimanual activities, and symmetrical posture and movement patterns.Īn historical cohort study was conducted to investigate the rate and extent of neurological recovery in obstetric brachial plexus injury (OBPI) and to identify possible prognostic factors in a cohort of children with OBPI from birth to 7 years. When necessary, the reconstructive procedure should be done by the age of three to six months. If the arm and hand function, especially flexion of the elbow, is not improving at the age of two months, the infant should be referred to the tertiary level rehabilitation centre and to department for plastic surgery at the University Medical Centre in Ljubljana. The newborn with IBP should be referred to physiotherapy, and then regularly followed-up once a month.
In the guidelines we propose to use the Toronto scale for evaluation of hand function. It is important to identify early signs of IBP and to evaluate the hand function. Risk factors for IBP are well known, but the mechanisms of impairment are not yet fully understood. The impairment of brachial plexus (IBP) in the neonate and infant remains an important problem.
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