Neonatal Med.  2019 Aug;26(3):128-137. 10.5385/nm.2019.26.3.128.

Clinical Features of Late-Onset Circulatory Collapse in Preterm Infants

Affiliations
  • 1Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea. choicw1029@gmail.com
  • 2Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
This study aimed to investigate the incidence and clinical features of late-onset circulatory collapse (LCC) in preterm infants.
METHODS
Medical records of 327 preterm infants (born before 32 gestational weeks) admitted to the neonatal intensive care unit of Seoul National University Bundang Hospital between January 2014 and December 2017 were reviewed. LCC was defined as sudden onset of refractory hypotension occurring after 7 days of life without obvious causes, which responded to glucocorticoid administration. Clinical characteristics and outcomes in infants with LCC were compared with those in infants with hypotension associated with identifiable causes, which developed after 7 days of life.
RESULTS
Among 327 preterm infants who enrolled in this study, 65 infants developed hypotension with oliguria after 7 days of life. Among these 65 infants, 35 (53.8%) met the criteria for LCC and 30 (46.2%) were diagnosed with hypotension associated with other identifiable causes. No statistically significant differences were observed in the baseline pre- and perinatal characteristics between infants with LCC and those with hypotension associated with other causes. Infants with hypotension associated with other causes showed a higher mortality rate than those with LCC (33.3% vs. 5.7%, P=0.004). The mean gestational age and birth weight of infants with LCC were 27+5±2+1 weeks and 963±245 g, respectively. LCC occurred at a mean postnatal age of 18 days. The median body weight at the time of diagnosis of LCC was 1,200 g. No association was observed between LCC and gestational age.
CONCLUSION
Among preterm infants born before 32 gestastional weeks who developed hypotension after 7 days of life, nearly 50% were diagnosed with LCC without apparent identifiable causes. Infants with LCC showed a lower mortality rate than those with hypotension associated with other causes.

Keyword

Late-onset circulatory collapse; Hypotension; Hydrocortisone; Infant, premature

MeSH Terms

Birth Weight
Body Weight
Diagnosis
Gestational Age
Humans
Hydrocortisone
Hypotension
Incidence
Infant
Infant, Newborn
Infant, Premature*
Intensive Care, Neonatal
Medical Records
Mortality
Oliguria
Seoul
Shock*
Hydrocortisone

Figure

  • Figure 1. Flow diagram of the study population. Abbreviations: LCC, late-onset circulatory collapse; HCS, hydrocortisone; PDA, patent ductus arteriosus; NEC, necrotizing enterocolitis; LD, low-dose; ACTH, adrenocorticotropic hormone.

  • Figure 2. (A) Gestational age (GA) and (B) birth weight distribution of 35 infants with late-onset circulatory collapse (LCC).


Reference

1. Sahni M, Jain S. Hypotension in neonates. NeoReviews. 2016; 17:e579–89.
2. Ahn HS, Shin HY. Pediatrics. 11th ed. Seoul: MiraeN;2016. p. 726–8.
3. Ibrahim CP. Hypotension in preterm infants. Indian Pediatr. 2008; 45:285–94.
4. Al-Aweel I, Pursley DM, Rubin LP, Shah B, Weisberger S, Richardson DK. Variations in prevalence of hypotension, hypertension, and vasopressor use in NICUs. J Perinatol. 2001; 21:272–8.
5. Ng PC, Lam CW, Fok TF, Lee CH, Ma KC, Chan IH, et al. Refractory hypotension in preterm infants with adrenocortical insufficiency. Arch Dis Child Fetal Neonatal Ed. 2001; 84:F122–4.
6. Noori S, Friedlich P, Wong P, Ebrahimi M, Siassi B, Seri I. Hemodynamic changes after low-dosage hydrocortisone administration in vasopressor-treated preterm and term neonates. Pediatrics. 2006; 118:1456–66.
7. Helbock HJ, Insoft RM, Conte FA. Glucocorticoid-responsive hypotension in extremely low birth weight newborns. Pediatrics. 1993; 92:715–7.
8. Fauser A, Pohlandt F, Bartmann P, Gortner L. Rapid increase of blood pressure in extremely low birth weight infants after a single dose of dexamethasone. Eur J Pediatr. 1993; 152:354–6.
9. Sasidharan P. Role of corticosteroids in neonatal blood pressure homeostasis. Clin Perinatol. 1998; 25:723–40.
10. Fernandez E, Schrader R, Watterberg K. Prevalence of low cortisol values in term and near-term infants with vasopressorresistant hypotension. J Perinatol. 2005; 25:114–8.
11. Oshiro M, Yamamoto H, Hosono H. Factors of late-onset circulatory collapse in the early nutrient and electrolyte management of extremely premature infant. J Jpn Soc Perinat Neonatal Med. 2006; 42:640–7.
12. Shimokaze T, Akaba K, Saito E. Late-onset glucocorticoidresponsive circulatory collapse in preterm infants: clinical characteristics of 14 patients. Tohoku J Exp Med. 2015; 235:241–8.
13. Seri I, Tan R, Evans J. Cardiovascular effects of hydrocortisone in preterm infants with pressor-resistant hypotension. Pediatrics. 2001; 107:1070–4.
14. Koyama N, Ohki S, Shirai K, Taihei T, Iwase K, Terasawa S, et al. Epidemiological examination by fact finding-multicenter study of the imperfect circulation (Chronic stage circulatory dysfunction: CSCD) transient for 12 acute phases after secession. J Jpn Soc Prematur Newborn Med. 2005; 17:412.
15. Kawai M. Late-onset circulatory collapse of prematurity. Pediatr Int. 2017; 59:391–6.
16. Miwa M, Kusuda S, Ikeda K. Late-onset circulatory collapse in very low-birthweight infants: a Japanese perspective. Neoreviews. 2009; 10:e381. –6.
17. Kobayashi S, Fujimoto S, Koyama N, Fukuda S, Iwaki T, Tanaka T, et al. Late-onset circulatory dysfunction of premature infants and late-onset periventricular leukomalacia. Pediatr Int. 2008; 50:225–31.
18. Masumoto K, Kusuda S, Aoyagi H, Tamura Y, Obonai T, Yamasaki C, et al. Comparison of serum cortisol concentrations in preterm infants with or without late-onset circulatory collapse due to adrenal insufficiency of prematurity. Pediatr Res. 2008; 63:686–90.
19. Choi EJ, Sohn JA, Lee EH, Lee JY, Lee HJ, Chung HR, et al. Clinical Picture of Adrenal Insufficiency-associated Hypotension in Preterm Infants. J Korean Soc Neonatol. 2011; 18:82–8.
20. Lee WJ, Kim MY, Cho HJ, Lee JS, Son DW. Clinical features of late-onset circulatory collapse in preterm infants. Korean J perinatol. 2013; 24:148–57.
21. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001; 163:1723–9.
22. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978; 92:529–34.
23. Rhee CJ, Kaiser JR, Rios DR, Kibler KK, Easley RB, Andropoulos DB, et al. Elevated diastolic closing margin is associated with intraventricular hemorrhage in premature infants. J Pediatr. 2016; 174:52–6.
24. Askenazi DJ, Ambalavanan N, Goldstein SL. Acute kidney injury in critically ill newborns: what do we know? What do we need to learn? Pediatr Nephrol. 2009; 24:265–74.
25. de Vries LS, Eken P, Dubowitz LM. The spectrum of leukomalacia using cranial ultrasound. Behav Brain Res. 1992; 49:1–6.
26. Chung HR. Adrenal and thyroid function in the fetus and preterm infant. Korean J Pediatr. 2014; 57:425–33.
27. Watterberg KL, Shaffer ML, Garland JS, Thilo EH, Mammel MC, Couser RJ, et al. Effect of dose on response to adrenocorticotropin in extremely low birth weight infants. J Clin Endocrinol Metab. 2005; 90:6380–5.
28. Cooper MS, Stewart PM. Adrenal insufficiency in critical illness. J Intensive Care Med. 2007; 22:348–62.
29. Volpe JJ. Confusions in nomenclature: "periventricular leukomalacia" and "white matter injury": identical, distinct, or overlapping? Pediatr Neurol. 2017; 73:3–6.
30. Vargo L, Seri I. New NANN practice guideline: the management of hypotension in the very-low-birth-weight infant. Adv Neonatal Care. 2011; 11:272–8.
31. Fanaroff JM, Fanaroff AA. Blood pressure disorders in the neonate: hypotension and hypertension. Semin Fetal Neonatal Med. 2006; 11:174–81.
32. Subhedar NV. Treatment of hypotension in newborns. Semin Neonatol. 2003; 8:413–23.
33. Kawai M, Kusuda S, Cho K, Horikawa R, Takizawa F, Ono M, et al. Nationwide surveillance of circulatory collapse associated with levothyroxine administration in very-low-birthweight infants in Japan. Pediatr Int. 2012; 54:177–81.
34. Masumoto K, Tagawa N, Kobayashi Y, Kusuda S. Cortisol production in preterm infants with or without late-onset adrenal insufficiency of prematurity: a prospective observational study. Pediatr Neonatol. 2018; Dec. 21. [Epub]. https://doi.org/10.1016/j.pedneo.2018.12.001.
35. Ng PC, Lee CH, Bnur FL, Chan IH, Lee AW, Wong E, et al. A double-blind, randomized, controlled study of a "stress dose" of hydrocortisone for rescue treatment of refractory hypotension in preterm infants. Pediatrics. 2006; 117:367–75.
36. Nakanishi H, Yamanaka S, Koriyama T, Shishida N, Miyagi N, Kim TJ, et al. Clinical characterization and long-term prognosis of neurological development in preterm infants with late-onset circulatory collapse. J Perinatol. 2010; 30:751–6.
37. Korte C, Styne D, Merritt TA, Mayes D, Wertz A, Helbock HJ. Adrenocortical function in the very low birth weight infant: improved testing sensitivity and association with neonatal outcome. J Pediatr. 1996; 128:257–63.
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