Retropharyngeal Abscess as a Cause of Bilateral Brachial Palsy in a Neonate

Neonatal brachial plexus palsy (NBPP) is caused by injury to the C5 to T1 nerve roots, which are responsible for both sensory and motor functions in the upper limbs. Importantly, NBPP is not always linked to delivery-related trauma. We present the case of a 16-day-old neonate who was evaluated in the emergency department for fever, lethargy, and skin pallor. In the context of an infection, the infant developed desaturation and a progressive loss of spontaneous mobility in the upper limbs, with the arms positioned in extension, adduction, and pronation. Suspecting an infectious complication in the upper cervical spine, an ultrasound was performed, followed by a computed tomography scan. The imaging revealed a retropharyngeal abscess that displaced the cervical spine and led to brachial paralysis. In this case, identifying the underlying cause of the paralysis enabled the prompt initiation of treatment, greatly improving the patient’s neurological prognosis and chances of survival.