Frequency and Risk Factors for Early Hypoglycemia in Full-term LGA Infants: A Retrospective Study

Purpose : The purpose of this study was to investigate the incidence of early hypoglycemia in full-term large-for-gestational-age (LGA) neonates within the first four hours of life, to identify associated neonatal and maternal risk factors, and to characterize the corresponding blood glucose patterns. Methods: We conducted a retrospective, single-center study reviewing medical records of full-term LGA neonates (birth weight >90th percentile) born from January 1, 2012, to December 31, 2021, and admitted to a well-baby nursery at a tertiary medical center in Southern Taiwan. Blood glucose was measured at 0.5, 1-, 2-, and 4-hours post-birth. Hypoglycemia was defined as blood glucose ≤40 mg/dL. Neonatal and maternal characteristics were compared between hypoglycemic and non-hypoglycemic groups. Results: Of 697 LGA neonates, 253 (36.3%) experienced hypoglycemia, with 98.42% of cases occurring within 1 hour (mean glucose: 40.26±8.16 mg/dL). Among 253 hypoglycemic neonates, 103 (40.7%) required intravenous glucose infusion for persistent hypoglycemia despite repeated early feeding. Multivariate logistic regression analysis identified respiratory distress (OR=2.24, 95% CI: 1.48–3.41), female sex (OR=2.05, 95% CI: 1.32–3.17), and maternal gestational diabetes mellitus (GDM) (OR=1.61, 95% CI: 1.12–2.32) were independent risk factors. Conclusion: Early hypoglycemia is prevalent in LGA neonates, particularly those with female sex, respiratory distress, or maternal GDM. Routine glucose screening within the first hour and early feeding are crucial in preventing severe hypoglycemic episodes.