A 5-Hour-Old Boy Is Evaluated in the Nursery for Minimal

question 570

Multiple Choice

A 5-hour-old boy is evaluated in the nursery for minimal right arm movement.  He was born at 39 weeks gestation to a 37-year-old multigravida via vaginal delivery complicated by difficulty extracting the shoulders.  Review of medical records reveals a maternal history of hypertension and recreational marijuana use.  The mother missed most of her prenatal appointments.  The patient's birth weight is 4.5 kg (9 lb 14 oz) .  Vital signs are normal.  Examination shows a plethoric infant with crepitus and irregularity over the right clavicle.  Moro reflex is absent on the right extremity.  Bilateral biceps and grasp reflexes are intact and symmetric.  Which of the following risk factors predisposed the infant to this complication?

• A)Congenital infection
• B)Fetal aneuploidy
• C)Fetal hyperglycemia
• D)Maternal hypertension
• E)Maternal marijuana abuse
• F)Maternal tobacco use

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