Damages to both sides occur less frequently and includes only 5% of all OBPP [1]. Just as with unilateral damages, it may occur due to mechanical trauma during delivery or intrauterine pathology. Injury is caused by concurrent traction, compression, fracture of the humerus and congenital torticollis [1], [2] and [3]. OBPP may be associated with paralytic dislocation of the shoulder [4]. There is an emphasis on the relationship of injuries with shoulder dystocia, fetal macrosomia or extremely high birth weight, maternal diabetes (it affects the child’s weight, proportions,

and perhaps more sensitive tissues), advanced maternal age or obesity, prolonged second stage of labor, clavicle fracture, and instrumental birth. Among intrauterine pathology factors, the SB203580 order most frequently

reported are fetal malposition (breech or transverse position), prematurity, oligohydramnios, compression of the umbilical cord wrapped around the neck of the child, uterine fibroids, muscular hypotension due to necrosis of the newborn, and CNS hypoxia [2], [3], [4] and [5]. Bilateral obstetric brachial see more plexus paralysis is a main complication in breech birth [6] and [7]. Damage may occur in the upper part of the plexus C5-C6 (Erb-Duchenne palsy), middle C7, C8-Th1, lower (Déjerine-Klumpke’s palasy) and in the whole plexus C5-Th1. A common injury is an upper – middle type C5, C6, C7. The anatomical division of injury includes preganglionical lesions, i.e. detachment of roots from the spinal cord (avulsion) and peripheral

lesions involving the roots, trunks, cords and nerves leaving the plexus. Many infants with OBBP have neuropraxia and recover spontaneously because neuropraxia tends to disappear within 4–6 weeks. Axonotmesis is a type of nerve injury requires regrowth of the axon to the target muscle, which takes a considerable amount of time (12–18 months) [4]. The consequences of injury are paresis, constrained positions, trophic disturbance and hypoplasia of the Metformin manufacturer shoulder girdle and upper limb, as well as motor and posture pattern changes [2] and [3]. One of the unfortunate sequelae in OBPP is upper limb length discrepancy [8]. The severity of OBPP determines the functional changes, the process of regeneration and appropriate treatment options. The boy was full-term from a second pregnancy born in a breech position with manual help, with a birth weight of 3200 g, asphyxia and an Apgar’s score of 1. Because of respiratory failure, immediately after delivery, he had to be treated in the Neonatal Intensive Care Unit (ICU) with artificial ventilation during seven days. He was diagnosed with encephalopathy. Increased muscle tension, periodic seizures, stiffening of the whole body, apnea and symptoms of renal impairment were observed. Neonatal Cranial Ultrasound showed minor periventricular leukomalacia (more on the right side).