# A nurse is caring for a large for gestational age (LGA) newborn who weighs 4,200 grams. Which nursing intervention should be the priority?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=543237  
> language: ko  
> subject: Maternal Newborn Health

## 문제

A nurse is caring for a large for gestational age (LGA) newborn who weighs 4,200 grams. Which nursing intervention should be the priority?

## 보기

1. Administer vitamin K injection immediately after birth
2. Monitor blood glucose levels closely and frequently **✔ 정답**
3. Assess for signs of respiratory distress syndrome
4. Initiate early skin-to-skin contact with the mother

**정답: 2**

## 해설

LGA newborns are at high risk for hypoglycemia due to hyperinsulinemia from maternal glucose exposure. Close blood glucose monitoring is the priority to prevent complications like seizures. Other interventions are important but not as time-sensitive.

## 심화 해설

Understanding the Priority for an LGA Newborn

When caring for a large for gestational age (LGA) newborn, the immediate priority is to anticipate and manage the most common and potentially dangerous metabolic complication: neonatal hypoglycemia. An LGA infant, often born to a mother with diabetes, has been exposed to high levels of glucose in utero. In response, the fetal pancreas produces a high level of insulin, a state known as fetal hyperinsulinemia. At birth, when the maternal glucose supply is abruptly cut off, this high circulating insulin level persists, causing a rapid and severe drop in the newborn's blood glucose. This makes monitoring blood glucose levels the highest priority nursing intervention.

The rationale is grounded in the prevalence and risks of this condition. Research specifically investigating LGA infants demonstrates that hypoglycemia, defined as a blood glucose level

## 임상 시나리오

Clinical Management of LGA Newborns at Risk for Hypoglycemia

The priority for a large for gestational age (LGA) newborn, especially one weighing over 4,000 grams, is aggressive screening and management for neonatal hypoglycemia. This condition stems from fetal hyperinsulinemia secondary to maternal hyperglycemia, most commonly in infants of diabetic mothers.

Screening Protocol

- **Initial Check:** Obtain a point-of-care blood glucose level within the first hour of life, ideally 30 minutes after the first feeding.

- **Frequency:** For asymptomatic at-risk infants, check glucose before feedings every 2-4 hours for the first 24 hours. Frequency increases to every hour if levels are unstable or the infant is symptomatic.

- **Target Levels:** Maintain a pre-feed glucose level >45 mg/dL (2.5 mmol/L) in the first 48 hours of life. A level

## 핵심 개념

- **Large for Gestational Age (LGA)** — A newborn whose birth weight is above the 90th percentile for their gestational age, often associated with maternal diabetes.
- **Neonatal Hypoglycemia** — A condition of low blood glucose in a newborn, commonly defined as a plasma glucose level less than 40-45 mg/dL, posing a risk for neurological injury.
- **Fetal Hyperinsulinemia** — A state of excessive insulin production by the fetal pancreas in response to chronic high glucose exposure in utero, leading to rapid hypoglycemia after birth when the maternal glucose supply is cut off.

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