Lga -Children ( “Large For Gestational Age”)

Infants weighing> 90th percentile are in terms of gestational age as LGA (large for gestational age) classified. Macrosomia is a birth weight of> 4000 g in an animal born to control time infant. The main cause is a maternal diabetes mellitus. Complications include. a. Birth trauma, hypoglycemia, hyper viscosity and hyperbilirubinemia.

The Fenton growth curves provide a more accurate assessment of growth vs. gestational age (Fenton growth curves for premature boys and Fenton growth curves for premature girls).

Infants weighing> 90th percentile are in terms of gestational age as LGA (large for gestational age) classified. Macrosomia is a birth weight of> 4000 g in an animal born to control time infant. The main cause is a maternal diabetes mellitus. Complications include. a. Birth trauma, hypoglycemia, hyper viscosity and hyperbilirubinemia. The Fenton growth curves provide a more accurate assessment of growth vs. gestational age (Fenton growth curves for premature boys and Fenton growth curves for premature girls). Apart from etiology of genetic size is a maternal diabetes mellitus, the most common cause of LGA infants. Macrosomia result of the anabolic effects of fetal high insulin levels, resulting in response to the high maternal blood sugar levels during pregnancy. The worse the maternal diabetes is set, the more severe the fetal macrosomia. A rare cause of non-genetic macrosomia the Beckwith-Wiedemann syndrome (indicated by large for gestational age, omphalocele, macroglossia and hypoglycemia). Rare causes of macrosomia are the Beckwith-Wiedemann syndrome (characterized by macrosomia, omphalocele, macroglossia and hypoglycemia), and the Sotos-, Marshall and Weaver syndrome. Symptoms, findings and treatment LGA children are big, obese and plethoric. The Apgar Who after 5 minutes (neonatal resuscitation: Assessment) may be low. These infants may be motionless and limp and drinking behavior can be reduced. Delivery problems may occur. Congenital anomalies and some metabolic and cardiac problems are specific to LGA children of diabetic mothers. Birth complications: Due to the considerable size of the infant vaginal delivery difficult and sometimes traumatic (birth injury) may be what specifically includes shoulder dystocia fracture of the clavicle or limbs Perinatal asphyxia Therefore, should a surgical delivery (cesarean section) should be considered if it is assumed that the fetus is too large for the pelvis (true cephalopelvisches mismatch). Other complications arise when the weight is> 4000 g. There are due to the following factors a proportional increase in morbidity and mortality before: shortness of breath (and need for ventilatory support, Idiopathic respiratory distress syndrome in newborns) meconium (meconium aspiration syndrome) hypoglycemia (neonatal hypoglycemia) polycythemia (Perinatal polycythemia and hyperviscosity syndrome) children of diabetic mothers: Children diabetic mothers are at risk of hypoglycemia hypocalcemia (Neonatal hypocalcemia) and hypomagnesemia (hypomagnesemia) polycythemia hyperbilirubinemia (neonatal hyperbilirubinemia) Respiratory distress Syndrome, certain congenital anomalies hypoglycemia is most likely in the first hours of life. This is due on the one hand the hyperinsulinism, on the other hand the sudden interruption of glucose delivery by the nut when the umbilical cord is disconnected. Neonatal hypoglycemia can be reduced by close-knit prenatal control of maternal diabetes and early, frequent feeding. Blood glucose levels should be closely monitored for 24 hours after birth at the bedside. If persistent hypoglycemia, parenteral intravenous glucose is added. Hypocalcemia and hypomagnesemia may occur, but are temporary and usually asymptomatic; Serum levels should be reviewed within the first 72 hours after birth. A good prenatal blood glucose control reduces the risk of neonatal hypocalcaemia. Hypocalcemia requires no treatment usually if no clinical manifestations of hypocalcemia or levels of <7 mg / dl present in term infants. The treatment is usually given to an intravenous supplementation of calcium gluconate. Hypomagnesemia may interfere with the secretion of parathyroid hormone, so hypocalcemia may not be responding to treatment until the magnesium level has been corrected. Polycythemia is slightly more common in children of diabetic mothers. Increased insulin levels increase the fetal metabolism and thus the O2 consumption. If the placenta can not meet the increased O2 demand occurs fetal hypoxemia that triggers an increase in erythropoietin and hematocrit. Hyperbilirubinemia occurs for several reasons. Children of diabetic mothers have a reduced tolerance for oral feeding (especially if they are premature babies), whereby the enterohepatic circulation of bilirubin is amplified in the first days of life. If polycythemia is present, the bilirubin-load is also increased. Respiratory Distress Syndrome (RDS) can occur because elevated insulin levels reduce surfactant production; lung maturation may thus be delayed pregnancy until late. RDS can develop even if the baby is late born prematurely or born in the regulation time. The lecithin / sphingomyelin ratio and v. a. the detection of phosphatidylglycerol in amniotic fluid obtained by amniocentesis can help to assess lung maturity and to determine the optimal time for a safe delivery. Only in the detection of phosphatidylglycerol may be expected of a mature lungs. A good prenatal blood glucose control can reduce the risk for RDS. The study of the hand is dealt with elsewhere (Idiopathic respiratory distress syndrome in newborns: Treatment). Transient tachypnea of ??the newborn (Transient tachypnea of ??the newborn) in children of diabetic mothers due to the delay of fetal lung fluid clarification to 3 times more likely 2. Congenital anomalies are more likely in children of diabetic mothers because the maternal hyperglycemia for organogenesis is harmful. Specific abnormalities include congenital heart disease (hypertrophic cardiomyopathy, ventricular septal defect, transposition of the great arteries and aortic stenosis) caudal regression syndrome spina bifida (spina bifida) syndrome of the small left colon Continuously elevated insulin levels may also lead to increased deposition of glycogen and fat in heart muscle cells. This deposit may cause transient hypertrophic cardiomyopathy, especially the septum. Important points Maternal Diabetes mellitus is the leading cause of LGA infants. Excessive body size itself increases the risk of birth injuries (z. B. fractures of the clavicle or the long bones of the extremities) and perinatal asphyxia. Children of diabetic mothers may have just given birth and metabolic complications including hypoglycemia, hypocalcemia and polycythemia. Children of diabetic mothers also are at risk for respiratory distress syndrome and congenital anomalies. Good control of maternal blood glucose levels to minimize the risk of complications.

Health Life Media Team

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