brand logo

Am Fam Physician. 2023;108(1):91-92

Author disclosure: No relevant financial relationships.

A newborn was admitted to the nursery following an assisted delivery. The 24-year-old mother (primigravida) had an uneventful pregnancy. After delivery, the newborn had inconsolable crying and intermittent tachypnea. She was placed on pulse oximetry. The nurse reported a heart rate of 140 beats per minute, with an oxygen saturation of 99% on room air. The family medicine resident was called to the bedside.

On examination, the chest was clear to auscultation. No cardiac murmur or radiofemoral delay were present. The infant had normal tone in all extremities. Blood pressure measurements in all four extremities were similar. Chest radiography was performed (Figure 1).


Based on the patient's history and physical examination findings, which one of the following is the best course of action?

  • A. Counsel and reassure the parents.

  • B. Obtain urgent echocardiography.

  • C. Perform complete workup for sepsis.

  • D. Transfer patient to the neonatal intensive care unit.


The answer is A: counsel and reassure the parents. A right midclavicular fracture was found on careful review of the radiograph. A neonatal clavicular fracture may occur during instrumental delivery, as in this case, and is often unavoidable. Macrosomia with higher birth weight is a common risk factor. The fracture usually heals spontaneously without treatment and has a good prognosis overall. Intervention is rarely indicated for nondisplaced fractures. Parental counseling and reassurance are important to alleviate concerns and anxiety.14

Already a member/subscriber?  Log In


From $165
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available

Issue Access

  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at To be considered for publication, submissions must meet these guidelines. Email submissions to

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of Photo Quiz published in AFP is available at

Continue Reading

More in AFP

More in PubMed

Copyright © 2023 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.