Question

Baby Leah had a very traumatic vaginal birth. After a vacuum extraction for fetal heart rate tracing changes and a resultant shoulder dystocia, Leah has a mild Erb's palsy, some facial and truncal bruising. The pediatrician has ordered physical therapy for the palsy, and the doctor expects routine care to be provided to her. Also, do not forget the education you must give to the new parents regarding this injury. Due to the bruising, there is an increase in bilirubin levels, and some behavioral changes occur with Leah. Phototherapy is discontinued at the hospital, but at home, the parents are encouraged to provide some 'routine' therapy for Hyperbilirubinemia.

     **What would you suggest? Do not forget routine discharge instruction for this parent.

Answer 1

Birth injuries are sustained during labour and delivery

Erb's palsy is characterised by paralysis of arm , often due to birth injury causing pressure on the brachial plexus or lower cervical nerve roots( 5 & 6 ) .

Physiological jaundice in newborn occurs within first few days of life is caused by breakdown of excessive number of red blood cells due to any cause and here in baby Leah its due to bruising.The routine therapy for this is most frequently feeding the baby with breast milk and if mother don't have breast milk supplemental formula feeding should be given according to physician's order. Also after two or three days after discharge a follow up should be made to meet the physician which is important to look for progression of jaundice . The mother must be advised to note how many wet diapers to ensure adequate feeding. Advice mother to place the newborn in a well-lit window for 10 minutes twice a day and not in direct sunlight.

Behavioural changes may occur because of pain like crying , not feeding well .

Educate the mother to meet the doctor if the baby has more yellowish skin than before, and if baby is not feeling well & always fuzzy.

Advice to check the stool and urine routine of the newborn.keep cord area clean and dry, if any secretion comes from the umbilicus or any smell meet the doctor.Follow immunization schedule.