AUTHOR=Levidy Michael F. , Azer Amanda , Shafei Jasmine , Srinivasan Nivetha , Mahajan Jasmine , Gupta Shivani , Abdelmalek George , Pant Krittika , Jain Kunj , Shah Yash , Zheng Zheshi , Chuieng-Yi Lu Johnny , Chang Tommy Nai-Jen , Chu Alice , McGrath Aleksandra TITLE=Global trends in surgical approach to neonatal brachial plexus palsy: a systematic review JOURNAL=Frontiers in Surgery VOLUME=Volume 11 - 2024 YEAR=2025 URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2024.1359719 DOI=10.3389/fsurg.2024.1359719 ISSN=2296-875X ABSTRACT=Background

We analyzed trends in age at surgery and surgical approach over time and geography.

Methods

We performed a systematic review according to PRISMA-IPD guidelines to include individual patient data. Collected data included age at surgery, location of surgery, and surgical approach. The surgical approach was independently categorized as the exploration of the brachial plexus (EBP) or nerve transfer without root exploration (NTwoRE). EBP was defined as exploring the brachial plexus in the supraclavicular fossa and applying a choice of coaptation procedures. NTwoRE included those sourcing donor nerves from, or entirely occurring outside of the plexus without exploring the root of the brachial plexus.

Results

Regression analysis of age at surgery 1985–2020 showed that age at BPBI surgery is rising (p < 0.05). Surgery was performed at a younger age in patients from Europe (7.06 ± 7.77 months) and Asia (7.58 ± 5.33 months) than those from North America (10.44 ± 5.01 months) and South America (14.71 ± 4.53 months) (p < 0.05). NTwoRE was more common in North America (37%) and least common in Europe (12%). Age at EBP was 7.2 ± 5.77 months, and age at NTwoRE was 15.85 ± 13.18 months (p < 0.05). The incidence of NTwoRE is increasing time.

Conclusions

Age at NBPP surgery is increasing over time. Regional differences exist in age at NBPP surgery. Approaches to NBPP surgery that avoid exploration of BP roots are becoming more popular. Age at EBP is lower than age at NTwoRE.