You are assisting in the care of a 3-day-old term baby girl who has brachial palsy and mild respiratory distress. The baby’s birthweight was 3.25 kg, and the delivery was complicated by posterior asynclitism, an oblique presentation of the infant’s head. Delivery of the infant from her exhausted mother was accomplished with “low” forceps. A cord wound tightly three times around the neck was reduced immediately. Because of a lack of respiratory effort, positive pressure ventilation was given for 2 minutes with bag and mask, producing a good response.

On physical examination, the baby is hypotonic and demonstrates a poor cry and suck. Her right arm is extended, internally rotated, and limp; only a slight grip is present. The Moro reflex is absent on that side. There is no movement at the shoulder or elbow. No swelling or crepitus is noted on examination of the arm and clavicle. Deep forceps...

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