Diaphragmatic paralysis in the newborn
- Ian J Griffin, MB ChB
Ian J Griffin, MB ChB
- Professor, Department of Pediatrics
- UC-Davis, Sacramento, CA
- Section Editors
- Joseph A Garcia-Prats, MD
Joseph A Garcia-Prats, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
- Gregory Redding, MD
Gregory Redding, MD
- Section Editor — Pediatric Pulmonology
- Professor of Pediatrics
- University of Washington School of Medicine
The most important of the respiratory muscles is the dome-shaped diaphragm, which separates the thoracic and abdominal cavities and is innervated by the phrenic nerve. Injury to the phrenic nerve associated with birth trauma or cardiothoracic surgery can result in diaphragmatic paralysis, which may lead to respiratory distress in newborns. The initial treatment is supportive, and spontaneous recovery occurs in most cases.
Before addressing the clinical features, diagnosis, and management of the disorder, reviewing the embryology and physiology of the diaphragm is useful.
The diaphragm develops from four embryologic structures:
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- DIAPHRAGM EMBRYOLOGY
- DIAPHRAGM PHYSIOLOGY
- Neonatal diaphragm
- - Rib cage attachments
- - Pressure generation
- - Fiber types
- - Body position
- Birth injury
- Cardiothoracic surgery
- Other procedures
- Neuromuscular disorders
- CLINICAL FEATURES
- PHYSICAL EXAMINATION
- Other imaging tests
- Electromyography and physiologic testing
- Surgical treatment
- - Outcome
- SUMMARY AND RECOMMENDATIONS