From the Research
The most effective reflex tests for diagnosing brachial plexus injury in newborns include the Moro reflex, grasp reflex, asymmetric tonic neck reflex, and Galant reflex, as they can be used to assess for asymmetry or absence on the affected side, allowing for early detection and intervention. When examining a newborn with suspected brachial plexus injury, clinicians should assess these reflexes, as they are non-invasive and can be performed during routine newborn examinations. The Moro reflex (startle reflex) is particularly important, as a unilateral absence suggests upper brachial plexus injury 1. The grasp reflex, tested by placing a finger in the infant's palm, may be diminished or absent in lower plexus injuries. The asymmetric tonic neck reflex should show extension of limbs on the face side and flexion on the occiput side when the head is turned; asymmetry suggests injury. The Galant reflex (trunk incurvation) may also be assessed. Additionally, clinicians should observe for Horner's syndrome (ptosis, miosis, anhidrosis), which suggests a more severe injury involving the sympathetic chain.
Some key points to consider when diagnosing brachial plexus injury in newborns include:
- The Moro reflex is a critical component of the examination, as it can indicate upper brachial plexus injury 1
- The grasp reflex can be used to assess for lower plexus injuries
- The asymmetric tonic neck reflex and Galant reflex can also be used to assess for injury
- Observation for Horner's syndrome is important, as it can indicate a more severe injury
It is essential to note that brachial plexus injury can result from excessive traction on the neck during difficult deliveries, and early detection and intervention are critical to improving outcomes 2, 3. By using these reflex tests, clinicians can quickly and non-invasively assess for brachial plexus injury in newborns, allowing for prompt referral for further evaluation and treatment if necessary.