Nerve transfers have gained popularity in the treatment of adult brachial plexus
palsy; however, their role in the treatment of
neonatal brachial plexus palsy (NBPP) remains unclear. Brachial plexus
palsies in infants differ greatly from those in adults in the patterns of injury, potential for recovery, and influences of growth and development. This International Federation of Societies for Surgery of the Hand committee report on NBPP is based upon review of the current literature. We found no direct comparisons of nerve grafting to
nerve transfer for primary reconstruction of NBPP. Although the results contained in individual reports that use each strategy for treatment of
Erb palsy are similar, comparison of
nerve transfer to nerve grafting is limited by inconsistencies in outcomes reported, by multiple confounding factors, and by small numbers of patients. Although the role of
nerve transfers for primary reconstruction remains to be defined,
nerve transfers have been found to be effective and useful in specific clinical circumstances including late presentation, isolated deficits, failed primary reconstruction, and multiple
nerve root avulsions. In the case of NBPP more severe than
Erb palsy,
nerve transfers alone are inadequate to address all of the deficits and should only be considered as adjuncts if maximal re-innervation is to be achieved. Surgeons who commit to care of infants with NBPP need to avoid an over-reliance on
nerve transfers and should also have the capability and inclination for brachial plexus exploration and nerve graft reconstruction.