A recent survey found that approximately 4% of very low birth weight infants in Japan were treated with glucocorticoids postnatally for circulatory collapse thought to be caused by late-onset adrenal insufficiency. We identified 11 preterm infants with clinical signs compatible with this diagnosis (hypotension, oliguria, hyponatremia, lung edema, and increased demand for oxygen treatment) and matched them for gestational age with 11 infants without such signs. Blood samples were obtained for cortisol and its precursors from the patient group before the administration of hydrocortisone, and from the control group during the same postnatal week. All samples were analyzed using a gas chromatography-mass spectrometry system. Cortisol concentrations did not differ between the two groups (6.6 Ϯ 4.5 vs 3.4 Ϯ 2.7 g/dL); however, the total concentration of precursors in the pathway to cortisol production was significantly higher in the patient group (72.2 Ϯ 50.3 vs 25.0 Ϯ 28.5 g/dL; p Ͻ 0.05). We conclude that the clinical picture of late-onset adrenal insufficiency in preterm infants is not a result of an absolute deficiency of cortisol production, but may be a result of a limited ability to synthesize sufficient cortisol for the degree of clinical stress. A ccording to a recent nationwide survey in Japan, about 4% of very low birth weight (VLBW) infants are treated with postnatal steroids because of adrenal insufficiency of prematurity (AOP). This condition was defined in the survey as postnatal steroid usage during a hospital stay for treatment of late-onset circulatory collapse in premature infants (1). Reports on glucocorticoid-responsive hypotension among VLBW infants in the early postnatal period suggest that the hypothalamus-pituitary-adrenal system does not function sufficiently in the immediate postnatal period (2-7), and, as a result, the serum cortisol level is relatively low during the first week of life (8 -13). However, it has been suggested that this adrenal insufficiency in preterm infants is transient and that adrenal function tends to return to normal by the end of the second week of life (14). Two randomized control trials have demonstrated the benefit of glucocorticoids for preventing and treating refractory hypotension during the first week of life in VLBW infants (15,16). Therefore, glucocorticoid-responsive hypotension was not considered a common phenomenon beyond the first week of life in this population. However, VLBW infants sometimes develop late-onset glucocorticoid-responsive circulatory collapse.The purpose of the current study differs from previous reports on the above pathophysiological etiologies, because we focused specifically on late-onset circulatory instability, which is usually prominent after the first week of life in preterm infants. AOP was defined as postnatal steroid treatment for late-onset (after the first week of life) adrenal insufficiency in premature infants. To elucidate the pathogenesis of this disorder, a comparison of steroid hormone concentrations between ...

The proposed set of ICD-10 codes encompasses the codes used in different countries for most SUDI cases. Use of these codes will allow for better international comparisons and tracking of trends over time.

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These catecholaminergic changes may be caused by chronic hypoxia or ischemia, and also may underlie alterations in respiratory and cardiovascular control in sleep.

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