Clinical Features of Late-onset Circulatory Collapse in Preterm Infants

Lee, Woon Ji; Kim, Min Young; Cho, Hye‐Kyung; Lee, Ji Sung; Son, Dong Woo

doi:10.14734/kjp.2013.24.3.148

Cited by 7 publications

(4 citation statements)

References 28 publications

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“…11 However, effectiveness of thyroid hormone supplementation in these 17 In a Korean study, LGCC developed a median of 16.5 days after birth and the onset peaked at 11e15 days after birth. 12 All infants in these studies were in a relatively stable condition without prodromal signs at the time of LGCC onset.…”

Section: Thyroid Hormone Supplementationmentioning

confidence: 92%

“…One study reported a 52% rate of hyponatremia (serum sodium <130 mEq/L) and 34% rate of hyperkalemia (serum potassium >6.0 mEq/L) in LGCC patients. 12 In a study comparing LGCC infants with gestational age-matched non-LGCC controls, hyponatremia (serum sodium <130 mEq/L) and hyperkalemia (serum potassium >5.5 mEq/L) incidences were significantly higher in LGCC infants. 17 In many patients with LGCC, hyponatremia is resistant to sodium supplementation.…”

Section: Electrolyte Imbalancementioning

confidence: 97%

“…10 In Korea, an incidence of 5.4e6.7% was reported in infants born at <33 weeks' gestation. 12,13 According to Japanese studies comparing LGCC with non-LGCC, gestational age and birth weight were significantly lower in LGCC, but multivariate analyses revealed low gestational age to be significantly associated with an increased LGCC risk. 9,18 Regarding fetal growth, small for gestational age was shown to increase LGCC risk.…”

Section: Definition and Incidencementioning

confidence: 99%

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Late-onset glucocorticoid-responsive circulatory collapse in premature infants

Iijima

2019

Pediatrics & Neonatology

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Late-onset glucocorticoid-responsive circulatory collapse (LGCC) in infants is characterized by sudden onset of hypotension and/or oliguria, which is resistant to volume expanders and inotropes but responds rapidly to intravenous glucocorticoids. LGCC occurs after the first week of life mainly in relatively stable very low birth weight (VLBW) infants. In Japan, the incidence of LGCC is reported to be 8%. Relative adrenal insufficiency (AI) is considered the most likely cause of LGCC, but its detailed pathophysiology remains unclear. Intrinsic and extrinsic factors may affect the pathophysiological mechanism. LGCC should be recognized as one of the highrisk complications in VLBW infants and managed promptly and properly, because if it is not, it may cause lifelong neurological problems. To diagnose relative AI, an accurate evaluation of adrenal function is necessary; however, the interpretation of basal serum cortisol levels is difficult in preterm infants after 7 days of life. To recognize LGCC, it is recommended that blood pressure and urine volume be carefully monitored, even outside of the transitional period. If no underlying causes are documented or volume expansion and inotropic support fail, intravenous hydrocortisone should be initiated, and an additional dose of hydrocortisone is required when the response is inadequate. There are few reports to verify or characterize LGCC and this phenomenon has not been recognized worldwide to date. This review summarizes the current knowledge about LGCC in premature infants and evaluates the most significant new findings regarding its pathophysiology, treatment, and prognosis.

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Section: Thyroid Hormone Supplementationmentioning

confidence: 92%

Section: Electrolyte Imbalancementioning

confidence: 97%

Section: Definition and Incidencementioning

confidence: 99%

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Late-onset glucocorticoid-responsive circulatory collapse in premature infants

Iijima

2019

Pediatrics & Neonatology

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“…Kawa et al [53] reported that the administration of levothyroxine was associated with an increased risk of late-onset circulatory collapse in VLBW infants, and that the first 2 weeks after the initiation of supplementation could be a high-risk period. However, the causal relationship was not proven in other studies [54-56]. Although there is incomplete evidence, but Japanese guidelines have recommended that hypothyroxinemia in LBW infants should not be treated with levothyroxine.…”

Section: Issues On Thyroid Hormone Replacementmentioning

confidence: 97%

Screening and management of thyroid dysfunction in preterm infants

Chung

2019

Ann Pediatr Endocrinol Metab

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Preterm infants can suffer various thyroid dysfunctions associated with developmental immaturity of the hypothalamic-pituitary-thyroid axis, postnatal illness, medications, or iodine supply. The incidence of thyroid dysfunction among preterm infants is higher than that among term infants and has been increasing with improvement in the survival of preterm infants. Hypothyroxinemia is frequently observed during the first week of life in extreme preterm neonates, and the incidence of delayed thyrotropin elevation is high at the age of 2–6 weeks. Although the necessity of routine rescreening remains controversial, recent guidelines on screening for congenital hypothyroidism have recommended rescreening of all preterm neonates. Thyroid hormone replacement is recommended for persistent thyrotropin elevation with or without hypothyroxinemia. Hypothyroxinemia without thyrotropin elevation does not require treatment, and some potential risks of levothyroxine supplementation have been reported. Although most thyroid dysfunctions are transient, careful follow-up after discontinuation of levothyroxine is considered so as to avoid missing persistent hypothyroidism.

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