{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T21:46:06Z","timestamp":1779313566314,"version":"3.51.4"},"reference-count":56,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Italian Ministry of Health with the Current Research funds"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Reports"],"abstract":"<jats:p>Diaphragmatic paralysis (DP) in neonates is a rare yet potentially life-threatening cause of respiratory distress, often resulting from obstetric trauma or cardiac surgery. This report presents two distinct cases of bilateral DP: one following a dystocic delivery with associated brachial plexus involvement, and the other linked to a genetic mutation (SYNGAP1) in a neonate with no birth trauma. Diagnosis was established through imaging, fluoroscopy, electromyography, and genetic testing. In both cases, conservative management was initially pursued; however, due to persistent respiratory failure, invasive interventions were required. The first patient underwent bilateral diaphragmatic plication with favorable outcomes, while the second required tracheostomy due to poor response to non-invasive ventilation with good outcome. These cases highlight the diagnostic and therapeutic challenges of neonatal DP, emphasizing the need for individualized treatment strategies in the absence of standardized guidelines. Early diagnosis and a multidisciplinary approach are crucial to optimize respiratory outcomes and reduce complications from prolonged mechanical ventilation.<\/jats:p>","DOI":"10.3390\/pediatric17060127","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T09:34:37Z","timestamp":1764581677000},"page":"127","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Two Rare Cases of Bilateral Diaphragmatic Paralysis in Neonates"],"prefix":"10.3390","volume":"17","author":[{"given":"Sara","family":"Ronci","sequence":"first","affiliation":[{"name":"Neonatal Intensive Care Unit, \u201cBambino Ges\u00f9\u201d Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4265-0939","authenticated-orcid":false,"given":"Chiara","family":"Maddaloni","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, \u201cBambino Ges\u00f9\u201d Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9306-9012","authenticated-orcid":false,"given":"Stefano","family":"Caoci","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, \u201cBambino Ges\u00f9\u201d Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6486-5201","authenticated-orcid":false,"given":"Stefano","family":"Pro","sequence":"additional","affiliation":[{"name":"Developmental Neurology Unit, \u201cBambino Ges\u00f9\u201d Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Longo","sequence":"additional","affiliation":[{"name":"Functional and Interventional Neuroradiology Unit, \u201cBambino Ges\u00f9\u201d Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0191-1880","authenticated-orcid":false,"given":"Andrea","family":"Conforti","sequence":"additional","affiliation":[{"name":"Neonatal Surgery Unit, Area of Fetal, Neonatal and Cardiological Sciences, \u201cBambino Ges\u00f9\u201d Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1260-6427","authenticated-orcid":false,"given":"Andrea","family":"Dotta","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, \u201cBambino Ges\u00f9\u201d Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Campi","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, \u201cBambino Ges\u00f9\u201d Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1055\/s-2007-979774","article-title":"Diaphragmatic paresis in newborns due to phrenic nerve injury","volume":"26","author":"Zifko","year":"1995","journal-title":"Neuropediatrics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1016\/S0022-3476(80)80442-2","article-title":"Bilateral diaphragmatic paralysis in the newborn infant","volume":"97","author":"Aldrich","year":"1980","journal-title":"J. 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