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. Pediatrician has ordered physical therapy for the palsy and the doctor expects routine care to be provided to her. In addition, 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. Please describe what is different and what will you discuss with the family to ensure safety?  The bilirubin level requires phototherapy. What precautions must you take?  What is essential to manage and treat the elevated bilirubin in addition to phototherapy? ..

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