SURGICAL-TREATMENT OF DIAPHRAGMATIC EVENTRATION CAUSED BY PHRENIC-NERVE INJURY IN THE NEWBORN

Background: Phrenic nerve palsy in infants and young children usually results from birth injury or iatrogenic damage. The newborn almost inv ariably presents with severe respiratory distress, diaphragmatic eleva tion, and paradoxical movement at the affected side. Methods/Results: In this retrospective analysis a group of 23 patients below the age of 1 year with an obstetric or postoperative phrenic nerve injury was st udied and compared with cases in the literature, All patients were adm itted between 1986 and 1997 to the Pediatric Surgical Center, Amsterda m, Thirteen of 18 patients with an obstetric phrenic nerve injury unde rwent plication of the diaphragm after an average observation period o f 100 days. In the remaining five children with an obstetric phrenic n erve injury, spontaneous recovery appeared within 1 month. Only one of five patients with a phrenic nerve palsy after a cardiac surgical pro cedure underwent plication of the diaphragm. Fifteen of the 34 patient s described in the literature underwent plication of the diaphragm aft er an average of 54 days. Conclusions: If after 1 month no spontaneous recovery of the diaphragmatic paralysis caused by a phrenic nerve inj ury occurs, plication of the diaphragm is indicated. This operation pr oved to be successful far relief of symptomatic phrenic nerve injury i n all cases, if the condition of the patient clinically deteriorates d uring this first month of life, the patient should be operated on imme diately. Copyright (C) 1998 by W.B. Saunders Company.