Case Report: Right phrenic nerve palsy following esophageal atresia repair: a report of two cases and literature review of management strategies.

BACKGROUND

Phrenic nerve palsy (PNP) following esophageal atresia (EA) repair is an extremely rare complication with limited global experience. This report of two cases, integrated with a literature review, aims to synthesize available evidence to propose a structured management strategy.

CASE PRESENTATION: We describe two neonates who developed right PNP after type III EA repair. Case 1 was diagnosed with right phrenic nerve palsy on postoperative day (POD) 7 via chest x-ray and ultrasound and achieved full recovery after five weeks of non-invasive respiratory support. Case 2 was diagnosed on POD 14; after six weeks of failed conservative management, the infant underwent successful diaphragmatic plication. Both infants had favorable outcomes at follow-up.

CONCLUSION

Based on the present cases and a review of all documented literature, we recommend a stepwise approach for managing post-EA repair PNP: Preventively, intraoperative phrenic nerve monitoring should be considered during EA/TEF repair to reduce the risk of iatrogenic injury. For diagnosed cases, we suggest early diagnosis using bedside x-ray and ultrasound, followed by an initial trial of 4-6 weeks of non-invasive support, with diaphragmatic plication reserved for weaning failure.