LARGE FOR DATE BABIES
Babies, born with birth weight of gt;90th percentile or 2 SD for their gestation, are termed as large for date (LFDs) babies.
TABLE 12.30: Causes of Large for Date Baby
12.12 THERMOREGULATION DISORDERS
• Constitutional
• Maternal diabetes, ovarian tumors
• Fetal: Hypothyroidism, congenital adrenal hyperplasia
• Chromosomal: Wiedemann-Beckwith syndrome
• Others: Hydrops fetalis, cerebral gigantism
Causes: Constitutional large size and infants of diabetes mother (IDM) are most common causes of LFDs in India, apart from others (Table 12.30).
Some unique causes of LFD are as follows:Wiedemann-Beckwith syndrome is probably a defect in chromosome 11, characterized by large body size (macrosomia), macroglossia, exomphalos, organomegaly, and characteristic groove on ear lobe along with other anomalies. These babies are prone for hypoglycaemia and Wilms' tumor.
Cerebral gigantism (Sotos syndrome) is of unknown etiology, characterized by large body size, large hands/ feet, macrognathia, and mental retardation.
Clinically, most LFDs are asymptomatic except their size and features of causative disease, if present. However, even the constitutional LFDs are prone for: (a) obstructed labor, (b) hypoglycemia, and (c) polycythemia.
Management includes close monitoring of hematocrit and blood glucose levels during first 72 hours, and regular feeding. Additional sugar/oil fortified EBM may be given to prevent hypoglycemia, polycythemia. Primary disease should be managed appropriately.
12.11.2