Neonatal diaphragmatic paralysis after a difficult delivery: a case report

• Autores: Sobrero, Helena, Allio, Natalia, Berazategui, Bernardo, Moraes, Mario
• Formato: artículo
• Fecha de Publicación: 2025
• Institución: Instituto Nacional de Salud del Niño San Borja
• Repositorio: INSNS - Revistas
• Lenguaje: español
• OAI Identifier: oai:ojs.pkp.sfu.ca:article/146
• Enlace del recurso: https://investigacionpediatrica.insnsb.gob.pe/index.php/iicqp/article/view/146
• Nivel de acceso: acceso abierto
• Materia: Recién Nacido; Parálisis Diafragmática; Distocia; Informes de Casos; Infant Newborn; Diaphragmatic Paralysis; Dystocia; Case Reports

Background: Diaphragmatic paralysis in neonates, secondary to phrenic nerve injury, is a rare but important cause of respiratory distress, particularly in the context of shoulder dystocia, and may go unnoticed in mild cases. It occurs due to lateral hyperextension of the neck during delivery, affecting the C3–C5 nerve roots, and is often associated with brachial plexus palsy. Case presentation: We report the case of a male neonate, born after a difficult delivery, who developed mild respiratory distress at 24 hours of life. Chest radiography and ultrasonography revealed elevation of the right hemidiaphragm and absence of excursion, confirming right diaphragmatic paralysis. Management was conservative, with supplemental oxygen administered via nasal cannula, resulting in favorable clinical progression and spontaneous resolution of the condition. Conclusion: The findings underscore the importance of considering diaphragmatic paralysis as a differential diagnosis in neonatal respiratory distress after a difficult delivery, even when symptoms are mild, to raise awareness among neonatal care professionals about an uncommon but clinically relevant complication. In addition, early imaging evaluation and conservative management are recommended in mild cases to avoid unnecessary invasive interventions.