A macrosomic infant (4550 g) is stable after a difficult forceps delivery. What is the priority nursing action?

• A. Assess newborn reflexes
• B. Leave the infant with the mother
• C. Obtain serum glucose levels frequently while observing closely for signs of hypoglycemia
• D. Perform a gestational age assessment

Answer: (C)

The key idea is that a macrosomic newborn, especially one from a diabetic mother, is at high risk for hypoglycemia after birth. Once the baby is no longer receiving glucose from the mother, insulin levels may remain high, causing glucose to drop rapidly. Because hypoglycemia can lead to serious neurologic complications, the most important early action is to monitor the baby’s blood glucose levels frequently and watch closely for signs such as jitteriness, poor feeding, lethargy, tachypnea, or temperature instability. Detecting low glucose early allows prompt treatment, starting with feeding to raise blood sugar and advancing to IV dextrose if needed per protocol.

Other assessments like newborn reflexes are useful for a general exam but don’t address this immediate metabolic risk. Leaving the infant without glucose monitoring could miss developing hypoglycemia, and while gestational age assessment is valuable, it isn’t the urgent priority in this scenario where hypoglycemia risk is the primary concern.