First experience of implantation of diaphragm pacemakers in infant with bilateral diaphragmatic paralysis

Phrenic nerve injury is not frequent, but well recognized complication of birth trauma caused by brachial plexus injury. Diaphragmatic paresis is usually unilateral, and cases of bilateral damage are rare. Diaphragmatic paralysis led to development of severe respiratory disorders, which required the prolonged intensive care, often with the applying of mechanical ventilation. Although is it possible the spontaneous restoration the function of the diaphragm, this requires the long-term of respiratory support. The general accepted guidelines of the treatment of infants with paresis/paralysis of diaphragm is absent. Diaphragmatic plication considered as the main surgical method of treatment. By that, diaphragmatic plication not always had a positive effect. The aim of the study was to present new possibility in the treatment of infants with bilateral diaphragmatic paralysis. Clinical case. We presented the first experience of transthoracic implantation of diaphragm pacemaker in infant with bilateral diaphragmatic paralysis. The newborn was hospitalized with the respiratory disorders’ syndrome. The paresis of both hemidiaphragms was reviled on chest X-ray. For 7 months child required the mechanical ventilation, due to unsuccessful attempts to transfer the child to spontaneous breathing caused the decrease of saturation. With the aim to restore spontaneous breathing, the implantation of diaphragm pacemaker, under the thoracoscopic control, was performed initially at the right side and next at the left side. The effectiveness of the treatment was confirmed by the electroneuromyography and ultrasonography. Conclusions. Implantation of the diaphragmatic pacemaker my be the method of treatment in infants with bilateral diaphragmatic paralysis. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.