Large-for-gestational-age infant and infants of diabetic mothers — viva

Stem

The examiner hands you the antenatal summary of a 39-week infant: birthweight 4350 g (above the 97th centile), maternal gestational diabetes managed with metformin with a high third-trimester HbA1c, a plump plethoric neonate with disproportionate shoulder adiposity, now jittery in the nursery. ^[4]

Examiner: What is your opening approach to this infant? ^[4]

Strong answer: I would first classify this as an infant of a diabetic mother with a hyperinsulinaemic macrosomic phenotype, because the mother has poorly controlled gestational diabetes and the infant has the disproportionate truncal adiposity and visceromegaly of hyperinsulinaemia rather than constitutional overgrowth. I would plot the weight, length and head circumference on a gestation- and sex-specific chart, then pre-empt the complications from the first feed — warmth, early and frequent feeding, scheduled pre-feed glucose monitoring, and the hypoglycaemia ladder. I would also screen for polycythaemia, respiratory distress, cardiomyopathy and birth injury. ^{[1] [2]}