Presentation
This neonate presented with erbs palsy , persisted respiratory distress after antibiotic treatment and history of assisted breech delivery.
Patient Data
The left side diaphragm M mode ultrasound study shows normal diaphragmatic motion with respiration, whereas the right M mode ultrasound of right diaphragm on second image shows paradoxical motion the diaphragm where the diaphragm moves away from the probe in inspiration and towards the probe during expiration suggesting right side diaphragmatic paralysis (phrenic nerve paralysis).
There is right side diaphragmatic elevation more than two intercostal spaces.
Case Discussion
Diaphragmatic paralysis in newborn is rare and underdiagnosed but serious condition in neonates which is mostly associated with traumatic delivery. There is usually associated ipsilateral brachial plexus injury. M mode ultrasound is gold standard for diagnosis showing either absent or paradoxical diaphragmatic motion. Treatment options include supportive management and surgical management (diaphragmatic plication) when indicated.