Big infants in the neonatal intensive care unit

Objective: This study was undertaken to identify risk factors for prolonged neonatal intensive care unit (NICU) stay in macrosomic (≥ 4000 g) neonates. Study design: A population-based case-control study in which 799 cases of macrosomic neonates with a prolonged NICU stay were compared with macrosomic neonates without a prolonged stay (n = 1598). Results: Significant risk factors included: 5-minute Apgar score less than 7: odds ratio (OR) = 43.1; fetal distress: OR = 3.0; birth length less than 20 inches: OR = 2.2; birth weight more than 5000 g: OR = 2.6; maternal diabetes: OR = 3.0; gestational age 37 to 38 weeks: OR = 2.2; cephalopelvic disproportion: OR = 2.5; primary cesarean: OR = 2.6; forceps/vacuum: OR = 1.7. No significant association was seen with labor induction/augmentation or dysfunctional/prolonged labor. Conclusion: Prolonged stay in macrosomic neonates was related to fetal distress measures and less to factors related to prolonged labor. Attention to intrapartum fetal status during labor with suspected macrosomia appears to be especially warranted.