The highest-priority complication to assess for immediately after birth in a macrosomic newborn is which?

• A. Hypoglycemia
• B. Hypocalcemia
• C. Hyperbilirubinemia
• D. Respiratory distress

Answer: (A)

When a baby is macrosomic, especially from a mother with diabetes, the fetus often has high insulin levels. After birth, the infant’s supply of glucose from the mother stops, but the insulin level remains high, causing blood glucose to drop rapidly. This makes hypoglycemia the most urgent issue to assess right away because low blood sugar can quickly affect the brain and lead to seizures or long-term neurologic problems if not treated promptly. Look for signs such as jitteriness, tremors, irritability or lethargy, poor feeding, cyanosis, apnea, or seizures, and check a blood glucose level immediately. If hypoglycemia is confirmed, treat quickly with glucose-containing feeds if the infant can feed, or with IV dextrose per protocol, and recheck glucose until stable. While other issues like hypocalcemia, hyperbilirubinemia, or respiratory distress can occur in macrosomic infants, the immediate priority is identifying and correcting hypoglycemia to protect the newborn’s brain.