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Self-biting behavior in patients with neonatal brachial plexus palsy

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Self-biting behavior in patients with neonatal brachial plexus palsy (NBPP) has been associated with finger amputation. Our objective is to describe the incidence of this complication, risk factors, and clinical management.


We retrospectively analyzed 612 patients with NBPP. There were 303 males and 309 females. 51.8% of patients had C5-C6 lesions, 28.9% had C5-C7, 18.9% had C5-T1, and 0.3 had C7-T1 involvement.


We identified 15 patients with self-biting behavior (2.5%). Ten patients had C5-T1 lesions, and five had C5-C7 lesions. Eight patents were submitted to brachial plexus surgery and seven were not. This behavior appeared between 8 and 46 months of life (mean 23.5), and it was always temporary. There was no difference between operated and non-operated patients (p > 0.05), and no correlation between age at surgery and age of appearance of self-biting behavior (p > 0.05). Physical restriction was effective in treating this complication and we had no case of finger amputation.


Self-biting behavior is a rare complication of NBPP, and it is usually associated with severe motor involvement. The behavior duration is limited to a few months. This condition can be effectively treated with physical restriction to prevent hand biting.

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Authors and Affiliations



COH, RSM, and MGS submitted the project. COH, MZ, and HSN reviewed patient data. COH, MZ, and RSM wrote the main manuscript. All authors reviewed the manuscript.

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Correspondence to Carlos Otto Heise.

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The authors declare no competing interests.

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Ethical approval was waived by the local Ethics Committee of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo in view of the retrospective nature of the study and all the procedures being performed were part of the routine care. The study was conducted in accordance with the declaration of Helsinki.

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There is no competing interest from any of the authors for this publication.

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Heise, C.O., Zaccariotto, M., Martins, R.S. et al. Self-biting behavior in patients with neonatal brachial plexus palsy. Childs Nerv Syst 38, 1773–1776 (2022).

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