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A 2-Hour-Old Boy Is Evaluated in the Newborn Nursery Due

question 779

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A 2-hour-old boy is evaluated in the newborn nursery due to an asymmetric Moro reflex. The infant was born via vaginal delivery to a 32-year-old woman, gravida 3 para 3. Labor was induced at 39 weeks gestation due to oligohydramnios noted on prenatal ultrasound. The mother received 5 doses of penicillin during labor for a positive test for group B Streptococcus. Labor was prolonged and required vacuum assistance due to difficult extraction. The pregnancy was complicated by gestational diabetes mellitus, which was not well controlled. The fetal lie was breech at 18 and 27 weeks gestation but was cephalic starting at 30 weeks. The infant weighs 4.6 kg (10 lb 3 oz, 99th percentile) . Finger-stick glucose was 39 mg/dL at birth and increased to 54 mg/dL after formula. The infant is sleeping but wakes during examination and cries. A large cephalohematoma is noted at the vacuum site. Cardiopulmonary examination is normal. The right arm is adducted and internally rotated and the forearm is pronated at rest. When the Moro reflex is elicited, the right arm has decreased movement. The palmar grasp reflex is present in both hands. Which of the following risk factors likely contributed to this patient's abnormal neurologic findings?

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The total cost of production (fixed plus variable costs) divided by the total quantity of output produced.

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