Effects of Erb’s Palsy in newborns

Our Blog | March 2, 2018

It’s a sad fact that not all pregnancies end in healthy bundles of joy born to delighted parents. Far too many new parents are devastated after their infants are born with significant birth defects, many of which may have been preventable.

Certainly mothers-to-be must be proactive about their, and their unborn babies’, health and safety. But the medical professionals tasked with overseeing the mothers’ pregnancies and deliveries must also remain vigilant about their patients’ conditions. When obstetricians or midwives drop the ball and something goes awry during a delivery, the consequences range from mild and temporary to permanently disabling.

Erb’s palsy goes by many names

Erb’s palsy is one common birth injury that occurs in one out of every 1,000 births in the U.S. Some misunderstandings about the condition stem from its being known by so many other names, including the following:

  • Neonatal brachial plexus palsy (NBPP)
  • Erb-Duchenne paralysis
  • Klumpke paralysis
  • Brachial palsy
  • Birth-related brachial plexus palsy
  • Obstetrical brachial plexus palsy

Regardless of the diagnostic name, the affected anatomy is the section of nerves in the shoulder that form the brachial plexus. If those nerves are damaged during the birthing process — for example, when the infant’s shoulder gets compressed against the mother’s pelvic bone in the birth canal — mobility loss and weakness in that arm can occur.

NBPP comes in 2 categories

The area of the arm that is affected and the degree of paralysis determine the category in which the diagnosis falls.

  • Upper-arm paralysis is the most common and includes the condition Erb-Duchenne paralysis
  • Far less common is Klumpke paralysis, affecting the infant’s hand and lower arm

The condition frequently is diagnosed in babies after their mothers endured difficult, extended birthing processes. Breech deliveries can exert pressure on the infants’ upper arms, putting them particularly at risk for developing this condition.

Other risk factors include diabetic mothers who can deliver babies considered to be larger-than-average and shoulder dystocia. The latter refers to problems affecting newborns’ shoulders after the head has emerged from the birth canal but the shoulders haven’t.

Symptoms of Erb’s palsy

Symptoms manifest immediately or shortly after a baby’s birth and can include:

  • Lack of movement in the upper or lower sections of the arm or in the hand
  • No involuntary movement known as the Moro reflex on one side of the body
  • The arm is held close to the body with the elbow flexed
  • The hand on one side of the body has a decreased grip

Treatment is possible in many cases, especially if the degree of damage is mild. The treatment plan may include range-of-motion exercises and gentle massage. More serious cases could improve with surgery. If there is no recovery in the first few months of a baby’s life, the condition is likely to be permanent and disabling.

Can this condition be prevented?

Medical advances in delivery techniques have made this specific birth injury diagnosed less frequently than it was in the past. Obstetricians that know or suspect their patients will experience difficult deliveries can plan Cesarean sections. While a C-section doesn’t preclude this diagnosis and carries additional risks to the baby and mother, it may lessen the risk of Erb’s palsy.

Obstetricians do make mistakes and may not be able to detect any pre-delivery issues in their patients that could lead to birth injuries. However, failing to observe obvious signs of pending problems might form the basis of a malpractice claim against the obstetrician or midwife overseeing the baby’s delivery.