Project for the implementation of a protocol for the treatment of children and newborns affected by Brachial Plexus birth palsy
Necessity of the project
According to the statistics of the world, three children among every two thousands of newborns can have the possible harms of Brachial Plexus Birth Plays in natural childbirth (and sometimes even a caesarean cases). This can cause paralysis of the arm also known as Erb's palsy. It may show itself immediately or sometimes with delay.
Brachial network damage (brachial plexus) at the time of birth is a traumatic lesion during childbirth which is occurred following high tension on the shoulder and neck with damaging the spinal nerves. The first symptoms of this damage is a weakness in the movements of the upper limb that can be classified
in different levels depending on the severity of the initial injury. The nerve damage is supraclavicular and mostly involves the upper limb. There is a 25 percent risk for the bottom limb to be involved.
The recent progress in natural childbirth techniques and a growth in number of caesarean did not diminish the risks of brachial plexus birth palsy. Although the factors that are known to cause this damage in newborns are Macroscopy, childbirth length, Shoulder dystocia and other cases, there is no final way to prevent brachial Plexus birth palsy. In fact, considering world wild cases, this damage can appear even during caesarian. Fortunately, in most cases, newborns suffering from this damage turn spontaneously back to their natural status, this because the initial injury was not severe. On average, 66 percent are treated within a year. Further research shows that in other cases, there is a 10 to 25 percent risk for the injury to be permanent. Thanks to the recent medical progress, it is possible to treat these injured kids; but because of a lack in specialized medical education and the absence of specific medical equipment needed for the treatment of these kids, a final cure for them cannot be provided time diagnosis and treatment can highly affect the successfulness of the treatment. In the
countries with high health index, these injured children are appropriately registered and specialized clinics are provided for their diagnosis, referral and treatment. Unfortunately, there is no study about epidemiologic and etiologic aspects, treatment methods and long term result of brachial plexus birth palsy in Iran. Based on our research, the cases treated in Iran have normally the injury diagnosed when side effects start to show and the patient is received at the academic referral stage. It results to be already late for a successful treatment, not being included in an appropriate medical care progress. This shows that there is a need of further research, more precise medical planning and implementation of international protocols so to have an on time diagnosis, a registration system, a complete referral, implementation of specialized clinic and trained personnel. Such a system would lead to a better administration and follow up of the patient and a comprehensive support service.
In order to solve this problem and diminish the risks of this injury, we face the following problems:
1. Lack of awareness of the patients about the existence of surgical treatment in maternity ward and pediatrician and gynecologists.
2. Lack of experience by pediatric hand orthopedic surgeons
3. Lack of consumable materials as biological surgical adhesive for nerve repair
1. Increase in knowledge of hand microsurgery medical team for the treatment of brachial plexus birth palsy
2. Appropriate recognition of the injured patient and start of the treatment process
3. Bringing awareness and informing the patients about the possibility of treating the injury by surgery in maternity and pediatric
4. Implementing infrastructures and supplying necessary equipment as biological surgical adhesive, microsurgical set need for the operation
1. Reduction of social effects for the children suffering from paralysis caused by brachial plexus birth palsy
2. Improving the situation of the families which children suffer from this treatable injury.
Implementation of the project
1. Dispatching surgeons for abroad training
The most important step for being able to carry out the microsurgical surgery and repair the nerve is to send our surgeons abroad for training. To be able to perform the surgery, it is necessary for at least 2 surgeon specialized in hand microsurgery to be sent to France for a long term training of at least 12 months, in order to gain experience alongside expert surgeons for Brachial Plexus birth palsy treatment
2. Necessary medical equipment Importation
Surgical biological adhesive (biomaterial collagen) needed fort the nerve repair costs more less
100 euros each
3. Microscopic surgical set Importation
Each set costs more less 3000 euros and it is needed for this specific surgery
4. Implementing infrastructures and necessary researches for identification, registration and referral of newborns patients for on time treatment
Need of sufficient advertisement, providing information and training in maternity war and between orthopedists for on time diagnosis, referral and treatment of children affected by brachial Plexus birth palsy