Infant Brachial Plexus Injuries: When to Refer Immediately and When to Wait

Apurva S. Shah, MD, MBA


April 30, 2019

Editorial Collaboration

Medscape &

Brachial plexus injuries in newborns are relatively common and can range from minor and self-limiting to severe with long-term effects on functioning. We spoke with Apurva S. Shah, MD, MBA, codirector of the brachial plexus injury program at Children's Hospital of Philadelphia (CHOP), for an update on recognition and management.

Can you update us on the epidemiology and mechanism of brachial plexus injuries?

Brachial plexus injuries in children are, by and large, injuries that happen at the time of delivery. A small minority—about 5% in my experience—occur in older children, and those are most often due to a motor vehicle collision or a high-energy traumatic event.

Brachial plexus injuries in newborns occur at an incidence of approximately 1.2 out of 1000 live births. Over the past few years, we've come to understand the epidemiology of these injuries much more. The incidence has dropped pretty substantially, by approximately 50% (47.1%), over the past 15 years. This is based on research we have completed at Children's Hospital of Philadelphia (CHOP) that was published in the Journal of Pediatric Orthopaedics.[1] We examined a national database that included information from approximately 5.5 million births, so we sampled a huge percentage of the US population to get these data.