A macrosomic infant, whose weight is above the 90th percentile of the average weight for the same gestational age or exceeds two standard deviations above the mean weight, falls under the category of large for gestational age (LGA). However, even if the birth weight is below 4000g, it is still classified as LGA as long as it exceeds the 90th percentile of the average weight for the same gestational age or is more than two standard deviations above the mean weight, regardless of whether the birth is premature, full-term, or post-term. The incidence rate is generally around 3–4%.

bubble_chart Etiology

The cause of disease

is often associated with the following factors: (1) genetic factors, where parents have a taller and larger physique; (2) pregnant women have a larger appetite and consume higher levels of protein; (3) maternal diabetes or Rh blood type incompatibility hemolytic disease between mother and baby, as well as Beckwith syndrome; pathological factors such as transposition of great arteries leading to elevated insulin levels.

Pathology

For large-for-gestational-age infants caused by genetic and nutritional factors, apart from being prone to birth injuries and hypoglycemia due to their larger size, there are no other abnormalities. However, elevated insulin levels caused by pathological factors can promote the synthesis of proteins, fats, and glycogen, leading to fetal obesity. The heart, liver, spleen, and other internal organs, as well as the placenta, are larger than those of normal infants, but not necessarily more mature. For example, in cases of Rh hemolytic disease, placental edema may occur, and the trophoblastic layer on the chorionic membrane of diabetic placentas may exhibit congestion and thickening. Due to their younger gestational age, lung development is immature, and a lack of alveolar surfactant increases the risk of neonatal respiratory distress syndrome. Infections are also more common compared to normal infants.

Infants of diabetic mothers are prone to intracranial hemorrhage and asphyxia during delivery. Excessive insulin levels can easily lead to transient hypoglycemia. Hypocalcemia is likely to occur when parathyroid function is low in utero. Paroxysmal dyspnea is mainly related to the lack of pulmonary surfactant. Hyperbilirubinemia occurring 2–3 days after birth is often associated with immature liver function and polycythemia. Additionally, polycythemia and increased blood viscosity may manifest as hyperviscosity syndrome, clinically often presenting with hematuria and renal insufficiency.

In RH hemolytic disease, large-for-gestational-age infants are often associated with anemia and edema, and the risk of concurrent hypoglycemia is also higher. Beckwith syndrome is primarily characterized by exophthalmos, macroglossia, and large body size, sometimes accompanied by umbilical hernia and malformations. Due to the frequent increase in islet cells, transient hypoglycemia is common. In cases of transposition of the great arteries, cardiac enlargement is observed, with clinical manifestations including cyanosis, dyspnea, and heart failure.

bubble_chart Treatment Measures

[Treatment Instructions]

Identify the cause, check for deformities during physical examination, initiate early feeding, provide high-risk monitoring, monitor blood glucose, and actively treat complications. For asymptomatic hypoglycemia, administer 10% glucose intravenously at 60ml/kg with a drip rate of 6–8mg/kg·min. For symptomatic cases or blood glucose below 1.68mmol/l (30mg/dl), first administer 25% glucose intravenously at 2–4ml/kg (1ml/min) before the drip.

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Normal large-for-gestational-age infants without birth trauma have a good prognosis. The prognosis for large-for-gestational-age infants of diabetic mothers is poor, with survivors having about 20 times higher risk of developing diabetes by young adulthood compared to others. Therefore, improving the quality of prenatal care and enhancing monitoring for high-risk pregnant women are crucial preventive measures.