Background: The syndrome of Rowland Payne is a rare triad of unilateral Horner syndrome, ipsilateral vocal cord paralysis, and ipsilateral paralysis of the hemidiaphragm.
Case: A healthy newborn was noted to have right ptosis, a weak hoarse cry, and stridor immediately following delivery with forceps. Pupillary miosis on the same side as the ptosis was observed. Chest X-ray showed elevation of the right diaphragmatic dome. A diagnosis of Rowland Payne syndrome was made. Neuroimaging did not reveal any structural mass lesions. The hoarseness and stridor resolved within 1 month without intervention. The Horner syndrome improved but did not disappear completely.
Conclusion: In the few reported cases in the literature, the cause of Rowland Payne syndrome has been a malignant lesion of the anterior neck disrupting the oculosympathetic nerve, the vagus nerve, and the phrenic nerve. This is the first report of Rowland Payne syndrome in a neonate. We did not find any malignancy or compressive lesion to account for his symptoms and signs. We suggest that shearing forces at the lower neck at the level of the clavicle caused stretching and mechanical injury to these motor nerves or their branches. In this report of Roland Payne syndrome related to birth trauma, the prognosis was favorable.