# Investigating Injury Tolerance and Mechanisms of Neonatal Brachial Plexus Palsy and Associated Injuries

> **NIH NIH R01** · WIDENER UNIVERSITY · 2022 · $486,382

## Abstract

Neonatal Brachial Plexus Palsy (NBPP) is a complication of childbirth that can result in significant long-term
sequelae. NBPP associated injuries often include cases of spinal cord injury (SCI) and are very poorly
understood. Our long-term research goals are to develop both prevention and treatment strategies for NBPP.
Consequently, objectives of this study are to use our novel and unique clinically-relevant neonatal piglet model:
a) To identify brachial plexus (BP) strains and forces that lead to morphological and functional SCI by
investigating the effects of BP stretch on acute pathology and functionality within the spinal cord (SC), b) To
investigate clinically-relevant systemic biomarkers for early diagnosis of SCI during NBPP, and c) To develop
computational models of maternal pelvis and fetus that predict risk of NBPP and associated SCI during
complicated NBPP delivery scenarios. Based on our preliminary work, our central hypothesis is that moderate
to severe BP stretches will transmit forces to SC resulting in SC tissue damage, which are also observable as
high expression of systemic injury biomarkers in the serum and cerebrospinal fluid, and suppression or loss of
motor neuron excitability. Our innovative approach is aimed at developing new knowledge of acute NBPP injury
mechanisms and report SCI tolerance values of BP strains and forces. These data will enable novel clinical tools
for diagnosis and prevention, as well as suggest targets for early clinical interventions for NBPP. We will test the
overall hypothesis through the following independent specific aims: 1) To determine whether moderate to
severe BP stretches will lead to SCI as evident by acute SCI markers in situ, functional loss in motor
neurons and systemic acute SCI biomarkers, and 2) To identify delivery maneuvers and NBPP risk
factors that lead to abnormal BP strains and forces, increasing the likelihood of associated SCI. The
expected outcomes of this work are the first ever data on: 1) morphological and functional injury outcomes that
help determine SCI tolerance values of BP strains and forces during BP stretch, 2) molecular biomarkers that
can enable early diagnosis of SCI, and 3) developing highly biofidelic computational models for NBPP prediction
and obstetric training. The results will also have an important positive impact, because, they lay the groundwork
to develop a new class of targeted clinical interventions.

## Key facts

- **NIH application ID:** 10366901
- **Project number:** 1R01HD104910-01A1
- **Recipient organization:** WIDENER UNIVERSITY
- **Principal Investigator:** Sriram Balasubramanian
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $486,382
- **Award type:** 1
- **Project period:** 2022-04-01 → 2022-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10366901

## Citation

> US National Institutes of Health, RePORTER application 10366901, Investigating Injury Tolerance and Mechanisms of Neonatal Brachial Plexus Palsy and Associated Injuries (1R01HD104910-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10366901. Licensed CC0.

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