Differential Diagnosis for the Newborn with Brachial Plexus Palsy
- Single Most Likely Diagnosis:
- Brachial Plexus Injury (BPI) due to shoulder dystocia: This is the most likely diagnosis given the clinical presentation of a brachial plexus palsy following a difficult delivery complicated by shoulder dystocia. The mechanism of injury during the delivery, including the need for maneuvers to facilitate delivery, supports this diagnosis.
- Other Likely Diagnoses:
- Birth asphyxia: The low Apgar scores (4 and 7 at 1 and 5 minutes, respectively) suggest that the infant may have experienced some degree of birth asphyxia, which could contribute to or exacerbate the neurological injury.
- Fractured clavicle or humerus: Although not directly stated, the difficulty during delivery and the presence of a brachial plexus palsy could be associated with a fracture, which is a common injury in the context of shoulder dystocia.
- Do Not Miss Diagnoses:
- Spinal cord injury: Although rare, a spinal cord injury could present with similar symptoms to a brachial plexus palsy and is a potentially devastating condition that requires prompt diagnosis and management.
- In utero injury or congenital condition: It is crucial to consider whether the brachial plexus injury could have occurred in utero or if there is a congenital condition affecting the brachial plexus, as these would have different implications for management and prognosis.
- Rare Diagnoses:
- Inherited neuropathies: Certain inherited conditions could predispose to neuropathies that might mimic a brachial plexus palsy, though these would be rare and typically associated with a family history.
- Neonatal stroke: Although extremely rare, a neonatal stroke could potentially present with focal neurological deficits, including those resembling a brachial plexus palsy, and would require urgent evaluation and treatment.