Korean J Perinatol.  2013 Sep;24(3):148-157. 10.14734/kjp.2013.24.3.148.

Clinical Features of Late-onset Circulatory Collapse in Preterm Infants

• Lee WJ
• Kim MY
• Cho HJ
• Lee JS
• Son DW

• KMID: 2280935
• DOI: http://doi.org/10.14734/kjp.2013.24.3.148

Abstract

PURPOSE
We aimed to describe the clinical features of late-onset circulatory collapse (LCC) in preterm infants.
METHODS
The records of preterm infants with a gestational age of <33 weeks who were admitted to a single neonatal intensive care unit and survived more than 72 hrs between March 2006 and August 2012 were reviewed retrospectively.
RESULTS
Of the total of 659 patients, 44 (6.7%) were diagnosed with LCC. Their mean gestational age was 26.0+/-1.9 weeks and their median birth weight 830 g. The median time of onset of LCC was 16.5 postnatal days. The patients exhibited oliguria that responded to hydrocortisone but not to hydration or catecholamines. Other clinical features of LCC were hypotension (73%), hyponatremia (52%), and hyperkalemia (34%). These abnormalities resolved in sequence: oliguria resolved first, after a median of 2.2 hrs, followed by hypotension after a median of 3.0 hrs, and the serum Na level became normal after 12.9 hrs. The incidence of LCC increased as the gestational age and/or birth weight decreased. A total of 26 patients (59%) developed LCC within 2 weeks after the initiation of levothyroxine therapy.
CONCLUSION
LCC in preterm infants was a relatively reversible condition but could be associated with severe morbidity. We therefore recommend the implementation of careful measures for early detection and prompt management of LCC, particularly after stressful events.

Keyword

Adrenal insufficiency; Hydrocortisone; Hypotension; Neonatal intensive care; Premature infant

MeSH Terms

Adrenal Insufficiency
Birth Weight
Catecholamines
Gestational Age
Humans
Hydrocortisone
Hyperkalemia
Hyponatremia
Hypotension
Incidence
Infant, Newborn
Infant, Premature*
Intensive Care, Neonatal
Life Change Events
Oliguria
Retrospective Studies
Shock*
Thyroxine
Catecholamines
Hydrocortisone
Thyroxine

Figure

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  Fig. 1 Histogram of the onset of late-onset circulatory collapse showed that the onset peaked between the 11th and 15th days of life. The LCC developed between the 6th and 40th days of hospitalization in most cases.

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  Fig. 2 The incidence of late-onset circulatory collapse increased as the gestational age decreased and the birth weight decreased.

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  Fig. 3 There was no association between the survival rate of patients with late-onset circulatory collapse and the gestational age. The survival rate tended to decrease as the birth weight decreased.

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