Hypoglycaemia and hypocalcaemia as determinants of admission birth weight criteria for term stable low risk macrosomic neonates

Abstract

Background : Large for gestational age (LGA) accounts for about 6.3% of admissions in kenyatta national hospital, newborn unit. As a policy all IGA’s, defined by birth weight of 4000g and above are admitted for 24hours to monitor blood glucose levels. The rational for this policy is questionable and contributes to unnecessary burden on resources needed for new born care. Objective: To study birth weight related incidence of hypoglycemia and hypocalcaemia in stable low risk lgas in knh and use it to establish a new admission weight based criteria. Patients and methods: prospective cohort study done in new born-unit, post natal and labour wards of knh. Term lga neonates (birth weight = 4000g) were recruited as subjects and controlled against term appropriate weight (aga) neonates. Results: the incidence of hypoglycemia and hypocalcaemia in lgas was 21% and 9% respectively. Hypoglycemia was rarely encountered after 12 hours of life in lgas. Hypoglycemia and hypocalcaemia showed a direct upward relationship with weight beyond 4250g. No significant difference in incidence of hypoglycemia and hypocalcaemia between controls and 4000-4249g category to justify their routine admission to newborn unit. Conclusion: the study identified 4275g as new admission birth weight criteria for stable term low risk IGA‘s admission.