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The objective of this study is to determine the incidence, significance, associated demographics and impact of macrosomic infants (≥4 kg) admitted to the Neonatal Intensive Care Unit (NICU) on NICU census and resources.A retrospective cohort review was performed from 2010 to 2015. Descriptive statistical analyses were used.Of 19 308 deliveries, 1823 were infants ≥ 4000 g and 213 were admitted to the NICU. Cesarean delivery occurred in 70% of the admitted infants, most (74.1%) were Grade 1 macrosomia and male (63%). Preterm birth occurred in 4%. The incidence of maternal diabetes was 25%. Primary admitting diagnoses were respiratory distress, suspected sepsis, hypoglycemia and perinatal depression. The average length of stay was 8 ± 6 days for all macrosomic infants admitted, increased to 22 ± 13 days for infants with Grade 3 macrosomia.Macrosomic infants are a growing population, who increase the demand on existing NICU resources. A larger multi-centered study is needed to determine the overall relevance of these findings in other populations.