Brain ultrasonographic findings of late-onset circulatory dysfunction due to adrenal insufficiency in preterm infants

Purpose: The aim of this study was to characterize the brain ultrasonographic findings of late-onset circulatory dysfunction (LCD) due to adrenal insufficiency (AI) in preterm infants. Methods: Among the 257 preterm infants born at <33 weeks of gestation between December 2009 and February 2014 at our institution, 35 preterm infants were diagnosed with AI. Brain ultrasonographic findings were retrospectively analyzed before and after LCD in 14 preterm infants, after exclusion of the other 21 infants with AI due to the following causes: death (n=2), early AI (n=5), sepsis (n=1), and patent ductus arteriosus (n=13). Results: Fourteen of 257 infants (5.4%) were diagnosed with LCD due to AI. The age at LCD was a median of 18.5 days (range, 9 to 32 days). The last ultrasonographic findings before LCD occurred showed grade 1 periventricular echogenicity (PVE) in all 14 patients and germinal matrix hemorrhage (GMH) with focal cystic change in one patient. Ultrasonographic findings after LCD demonstrated no significant change in grade 1 PVE and no new lesions in eight (57%), grade 1 PVE with newly appearing GMH in three (21%), and increased PVE in three (21%) infants. Five infants (36%) showed new development (n=4) or increased size (n=1) of GMH. Two of three infants (14%) with increased PVE developed cystic periventricular leukomalacia (PVL) and rapid progression to macrocystic encephalomalacia. Conclusion: LCD due to AI may be associated with the late development of GMH, increased PVE after LCD, and cystic PVL with rapid progression to macrocystic encephalomalacia.

[1]  Tomoyuki Shimokaze,et al.  Late-onset glucocorticoid-responsive circulatory collapse in preterm infants: clinical characteristics of 14 patients. , 2015, The Tohoku journal of experimental medicine.

[2]  H. Nakanishi,et al.  Hemodynamic analysis in infants with late‐onset circulatory collapse , 2013, Pediatrics international : official journal of the Japan Pediatric Society.

[3]  Chang Won Choi,et al.  Late-onset Hypotension and Late Circulatory Collapse Due to Adrenal Insufficiency in Preterm Infants with Gestational Age Less than 32 Weeks. , 2011 .

[4]  Eun Hee Lee,et al.  Clinical Picture of Adrenal Insufficiency-associated Hypotension in Preterm Infants. , 2011 .

[5]  H. Bassan.  Intracranial hemorrhage in the preterm infant: understanding it, preventing it. , 2009, Clinics in perinatology.

[6]  N. Tagawa,et al.  Comparison of Serum Cortisol Concentrations in Preterm Infants With or Without Late-Onset Circulatory Collapse due to Adrenal Insufficiency of Prematurity , 2008, Pediatric Research.

[7]  S. Fujimoto,et al.  Late‐onset circulatory dysfunction of premature infants and late‐onset periventricular leukomalacia , 2008, Pediatrics international : official journal of the Japan Pediatric Society.

[8]  S. Fujimoto,et al.  Periventricular leukomalacia with late-onset circulatory dysfunction of premature infants: correlation with severity of magnetic resonance imaging findings and neurological outcomes. , 2006, The Tohoku journal of experimental medicine.

[9]  M. Fujimura,et al.  Morbidity and Mortality of Infants With Very Low Birth Weight in Japan: Center Variation , 2006, Pediatrics.

[10]  R. Ehrenkranz,et al.  Delayed hemorrhagic infarction. A cause of late neonatal germinal matrix and intraventricular hemorrhage. , 1984, Archives of neurology.

[11]  S. Yagel,et al.  Selective reduction of blood flow to white matter during hypotension in newborn dogs: A possbile mechanism of periventricular leukomalacia , 1982, Annals of neurology.