LARGE-FOR-GESTATIONAL-AGE

An infant is LGA (also termed as macrosomia) if the birth weight is above the 90th percentile
on an intrauterine growth chart for that gestational age.
Baby appears deceptively healthy at birth because of the weight, but a gestational age
examination often reveals immature development.
Needs immediate identification so they can be given care appropriate for their gestational
age.
ETIOLOGY

Infants who are LGA have been subjected to an overproduction of nutrients and growth

hormone in utero.
Happens most often to infants whose women are obese or who have diabetes mellitus.
Multiparous women may also have large babies.
Beckwith-Wiedemann syndrome, a rare condition characterised by general body overgrowth
and congenital anomalies such as omphalocele, may also be a cause.
ASSESSMENT

Womans uterus appears to be unusually large for the date of the pregnancy.
Fetus does not occupy significantly more space at 10 lb than at 7 lb.
Sonogram - can confirm if the fetus does seem to be growing at an abnormally rapid rate.
Non stress test - may be prescribed to assess the placentas ability to sustain a large fetus
during labor.
Amniocentesis - to assess lung maturity.
If an infants size was not detected during pregnancy, it may be recognised during labor when
the baby appears too large to descend through the pelvic rim. Thus, a cesarean birth may be
necessary because shoulder dystocia (the wide fatal shoulders cannot pass through the
outlet of pelvis) would halt vaginal birth at that point.
Appearance

immature reflexes at birth

low scores on gestational age examinations in relation to their size
have extensive bruising or a birth injury such as broken clavicle
because of the large head, it may have been exposed to more than the usual amount of
pressure during birth, causing a prominent caput succedaneum, cephalohematoma, or
molding
same cautious care necessary for preterm infant is required
Cardiovascular Dysfunction

Polycythemia may occur in an LGA fetus.

Observe for signs of hyperbilirubinemia that may result from absorption of blood from bruising
and breakdown of extra red blood cells created by polycythemia.
Assess infants heart rate.
Cyanosis = sign of poor heart function
Hypoglycemia

Large infants requires large amounts of nutritional stores to sustain their weight.

 Mother had diabetes that was poorly controlled (the cause of the large size) = infant would

have an increased blood glucose level in utero to match the mothers glucose level; infant will
produce elevated levels of insulin
After birth, these increased insulin levels will continue for up to 24 hours of life, possibly
causing rebound hypoglycemia.